A group of self-advocates is calling out federal health officials for publicly supporting community-based services for people with disabilities while quietly advising states on options to curtail such programs.

The brouhaha comes after federal officials outlined ways in which states could modify their home and community-based services offerings without violating so-called maintenance of effort requirements in a letter to state Medicaid directors late last week.

Among the possibilities, states could alter benefits, rates or set new criteria for individuals to receive specific services under a Medicaid home and community-based waiver, wrote Cindy Mann, who oversees Medicaid at the Centers for Medicare and Medicaid Services.

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States may also allow their waivers to expire and are under no obligation to renew them, Mann said.

The guidance to states is roiling members of ADAPT, a national group of self-advocates, who staunchly support community-based services.

“This is reprehensible,” said Rahnee Patrick, an ADAPT organizer from Chicago, Ill., who questioned how the letter could come just weeks after U.S. Health and Human Services Secretary Kathleen Sebelius made public comments in support of community living.

During a speech in late July to members of the American Association for People with Disabilities, Sebelius spoke of the Obama administration’s “deep commitment to helping people live as independently as possible.”

“While the secretary gave rousing speeches and was applauded by our community, her staff were crafting guidance to states on cutting our services,” Patrick said.

Officials at the Centers for Medicare and Medicaid Services did not immediately respond to questions about the letter.

However, in her correspondence to states, Mann did take pains to point out that while changes may be allowed under health law, it does not mean they’re necessarily advisable. That’s because limits on community-based services could put states in violation of the Americans with Disabilities Act and the Supreme Court’s decision in Olmstead v. L.C., which found that people with disabilities should have the option of living in the community whenever possible.