A recent OIG report examined the extent to which home and community-based services (HCBS) for beneficiaries residing in assisted living facilities (ALF) furnished under a section 1915(c) waiver comply with federal and state requirements. Based on sample of 150 beneficiaries in the seven states with the highest numbers of beneficiaries receiving HCBS in ALFs (Georgia, Illinois, Minnesota, New Jersey, Oregon, Texas, and Washington) in 2009, the OIG found that ALFs did not always comply with federally-mandated standards. For instance, most beneficiaries in these states (77%) received HCBS under the waiver in ALFs cited for a deficiency with regard to at least one state licensure or certification requirement. The OIG recommends that CMS issue guidance to state Medicaid programs that emphasizes the need to comply with federal requirements for covering HCBS under the 1915(c) waiver.