Inside the Medicaid HCBS Waiver Research
Medicaid HCBS waivers are the largest funding stream for people with IDD. However, although states’ ability to tailor their HCBS programs has many benefits, it also results in wide variance across states and programs.
What Are Medicaid HCBS Waivers?
Medicaid in its modern form began in the 1960s in order to provide a mechanism for states to offer medical and non-medical services to people in poverty, including those needed by individuals with chronic care needs. As a result of the introduction of Medicaid Home and Community Based Services (HCBS; 1915(c)) waivers, states are able to create and expand community long-term services and supports (LTSS) particularly tailored to populations that would typically require institutional care to allow them to live in their own home or community instead, such as people with IDD. To do so, HCBS waivers allow states the flexibility to determine not only who is eligible and how many people are served, but also what benefits their HCBS program/s will cover and the ways those benefits are provided.
National-level state-specific analyses of HCBS waivers for people with IDD are crucial. Though this research project we have conducted national analyses of waivers for people with IDD to examine if, and how, states provide HCBS services, including the projected number of users, total projected spending, the average annual service allocation per participant, and the services provided, including a close analysis of various service categories. All of the aforementioned analyses are necessary to determine how states and waivers prioritize different service categories and lines, determine areas of need, and provide guidance on how states can best capitalize on the limited funding available to them.