42 CFR § 441.305 - Replacement of beneficiaries in approved waiver programs.

---
identifier: "/us/cfr/t42/s441.305"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 441.305 - Replacement of beneficiaries in approved waiver programs."
title_number: 42
title_name: "Public Health"
section_number: "441.305"
section_name: "Replacement of beneficiaries in approved waiver programs."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "C"
subchapter_name: "MEDICAL ASSISTANCE PROGRAMS"
part_number: "441"
part_name: "SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES"
positive_law: false
currency: "2026-03-24"
last_updated: "2026-03-24"
format_version: "1.1.0"
generator: "[email protected]"
authority: "42 U.S.C. 1302."
regulatory_source: "43 FR 45229, Sept. 29, 1978, unless otherwise noted."
cfr_part: "441"
---


# 441.305 Replacement of beneficiaries in approved waiver programs.

(a) *Regular waivers.* A State's estimate of the number of individuals who may receive home and community-based services must include those who will replace beneficiaries who leave the program for any reason. A State may replace beneficiaries who leave the program due to death or loss of eligibility under the State plan without regard to any federally-imposed limit on utilization, but must maintain a record of beneficiaries replaced on this basis.

(b) *Model waivers.* (1) The number of individuals who may receive home and community-based services under a model waiver may not exceed 200 beneficiaries at any one time.

(2) The agency may replace any individuals who die or become ineligible for State plan services to maintain a count up to the number specified by the State and approved by CMS within the 200-maximum limit.

[59 FR 37719, July 25, 1994]