42 CFR §432.31

1. (a)State plan requirement. A State plan must provide for the training and effective use of subprofessional staff as community service aides, in accordance with the requirements of this section.
2. (b)Recruitment and selection. The Medicaid agency must have methods of recruitment and selection that afford opportunity for full-time or part-time employment of persons of low income, including:
   1. (1)Young, middle-aged, and older persons;
   2. (2)Physically and mentally disabled; and
   3. (3)Beneficiaries.
3. (c)Merit system. Subprofessional positions must be subject to merit system requirements except where special exemption is approved on the basis of a State alternative plan for employment of disadvantaged persons.
4. (d)Staffing plan. The agency staffing plan must include the kinds of jobs that subprofessional staff can perform.
5. (e)Career service. The agency must have a career service program that allows persons:
   1. (1)To enter employment at the subprofessional level; and
   2. (2)To progress to positions of increasing responsibility and reward:
      1. (i)In accordance with their abilities; and
      2. (ii)Through work experience and pre-service and in-service training.
6. (f)Training, supervision and supportive services. The agency must have an organized training program, supervision, and supportive services for subprofessional staff.
7. (g)Progressive expansion. The agency must provide for annual increase in the number of subprofessional staff until:
   1. (1)An appropriate ratio of subprofessional and professional staff has been achieved; and
   2. (2)There is maximum use of subprofessional staff as community aides in the operation of the program.