title: Medicaid 1915(c) home and community-based services waivers: a national survey of eligibility criteria, caps, and waiting lists.
abstract: With 43 states reporting budget deficits in 2002, there is increasing interest in the cost controls methods that state governments use on the 229 Medicaid home and community-based services (HCBS) waiver programs which, in 2001, provided services to more than 830,000 persons and cost more than $14.2 billion. This paper reports findings from a national survey of all waiver programs regarding cost containment strategies used in 2002. Responses from 76 percent of all waivers show that 57 percent used some type of financial cap, 33 percent used more restrictive financial eligibility criteria than for institutional services, and the vast majority of states limited the number of waiver slots available. Overall, the waiver programs reported that 157,640 persons were on waiting lists in 2002. These findings provide an important basis for comparison between states because the use of these strategies may restrict individuals' choice of services and result in unnecessary institutionalization.
authors.affiliation: Center for Personal Assistance Services, Department of Social and Behavioral Sciences, University of California, 3333 California Street, Suite 455, San Francisco, CA 94118, USA. martink@itsa.ucsf.edu
authors.forename: Martin
authors.initials: M
authors.lastname: Kitchener
authors.forename: Terence
authors.initials: T
authors.lastname: Ng
authors.forename: Charlene
authors.initials: C
authors.lastname: Harrington
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D003363:Cost Control / Q000379:methods; D004608:Eligibility Determination / Q000145:classification / Q000331:legislation & jurisprudence*; D005102:Health Expenditures / Q000331:legislation & jurisprudence / Q000639:trends; D006291:Health Policy / Q000191:economics / Q000331:legislation & jurisprudence*; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000191:economics* / Q000706:statistics & numerical data; D008484:Medicaid / Q000191:economics / Q000331:legislation & jurisprudence*; D020380:Needs Assessment; D011203:Poverty; D013221:State Health Plans / Q000191:economics / Q000331:legislation & jurisprudence*; D011795:Surveys and Questionnaires; D014481:United States; D014850:Waiting Lists