Systematic Documentation of State Variation in Medicaid Home- and Community-based Services: The Medicaid Home and...

In the United States, Medicaid plays a prominent and growing role as a primary payer for home- and community-based services (HCBS) to help adults remain living independently in the community. While Medicaid HCBS programs vary significantly across states, limited historical, systematic data about Medicaid HCBS program components exist. We presented a systematic, reproducible approach to capture comprehensive characteristics of Medicaid HCBS waivers.

We used current and historical documentation of Medicaid 1915(c) waivers serving adults ages 65 or older from 2010 to 2019. We described waiver services available over time, specifically respite, transport, meals/dietary/nutrition services, caregiver training, and payments to family members for personal care services. We extracted data from waiver documents using HTML parsing.

We extracted data systematically from 419 of 431 waiver documents (97%) across 46 states. During a manual quality control review of data extracted, 9% of waiver documents required any manual corrections, with only 4% requiring significant corrections impacting analysis (eg, missing services). We observed that the percentage of waivers offering each service increased over time for most services except caregiver training, which decreased.

This study fills a critical gap in data availability by demonstrating a systematic approach by which researchers can construct a historical, waiver-level database of Medicaid HCBS waiver characteristics.