The use of Medicaid waivers and their impact on services

This article examines Medicaid waivers to provide services to adults with traumatic brain injury (TBI) who are Medicaid eligible in the community and who would otherwise be placed in nursing homes or who meet nursing home levels of care. Medicaid waivers for individuals with TBI were addressed through a review of six TBI Waivers (Colorado, Idaho, Kansas, New York, Rhode Island, and Vermont). A summary of the services covered by the waivers is provided. Review of the data suggests two processes, obtaining a waiver and implementing a waiver. Four characteristics were linked to obtaining waivers (a) social-medical-political climate, (b) similarity to other waivers, (c) ability to strengthen access and reduce barriers, and (d) expenditure of resources. Similarly, four theoretical characteristics were posited to be associated with managing waivers: (a) cost effectiveness, developmental process of waiver implementation, (c) ability to improve access and reduce barriers, and (d) expenditure of resources to manage the waiver.