If families want to private pay for their family member to live in essentially a gated community, then that is certainly their right. However, if Medicaid Waiver Funds are to be considered, then all regulations, rules, best practices etc. should also apply.  If they do not have to abide by the same rules, this looks like preferential treatment based on who you know. There have been programs who have had to drastically change or modify their locations and way of doing business to meet these standards.  My question remains, don't the Medicaid Waiver Regulations including HCBS, apply to all?