Access of target groups to 1915(c) Medicaid home and community based waiver services

The study examined the access of specific target groups to the 1915(c) home and community based waiver program in terms of the number of participants, services, and expenditures for 1992 and 1997.

The study collected HCFA 372 waiver program statistics from each of the states and compared statistics for the two time periods. A regression examined the increase in program expenditures.

An unequal distribution of HCBS expenditures across target groups was found where individuals with developmental disability were 39 percent of participants but used 77 percent of the total $7.9 billion waiver expenditures in 1997. The aged and disabled were 58 percent of waiver participants but received 21 percent of expenditures. The program growth was primarily due to increases in participants and reimbursement rates.

Individuals with MR/DD used more costly services such as habilitation and residential care than other target groups. Studies are needed to examine what accounts for the unequal access and whether program expenditures are sufficient to meet the long-term care needs of various target groups.