Medicaid 1915(c) Home and Community-Based Services Waivers Across the States. Health Care Financing Review. Fall. Forthcoming

This article provides State-level data on the Medicaid 1915(c) home and community-based services (HCBS) waivers program. Medicaid 1915(c) waiver participants were 32 percent of the Medicaid participants in institutional care in 1997. These data doc ument wide interstate variation in organi zational oversight and program policies for the waivers. Many structural barriers to HCBS waiver growth existed. Case man agement services, in some form, were nor mative for most HCBS waiver participants, but formal mechanisms to assess client sat isfaction and service quality were less com mon. Substantial new growth in this pro-gram may require fundamental changes in HCBS waiver policies