10.1177/073346402237636Journal of Applied GerontologyHar ington et a. / Met & Unmet Need for Medicaid Services Met and Unmet Need for Medicaid Home- and Community-Based Services

This study examined the met and unmet need for Medicaid personal care services (PCS) and home- and community-based service (HCBS) waivers across the states. Medicaid directors and state officials working with PCS and HCBS were interviewed by telephone in l998-1999 to col-lect descriptive and statistical data. A total of 26 states offered PCS to 467,487 participants in l998-1999, and 49 states offered waiver services to 561,510 participants in l997. In spite of wide variations in total HCBS participants per capita, 42 states reported inadequate waiver slots and waiting lists. Even in states with the highest participant rate per capita, state officials reported waiting lists for the HCBS waiver program and many target groups that were not adequately cov-ered by the current HCBS waivers. A number of barriers existed to expanding HCBS services, including an inadequate supply of home- and community-based providers, limited state legisla-tive support for the programs, and federal regulatory barriers such as restrictions on need criteria. Historically, Medicaid long-term care (LTC) has been nearly synonymous with institutional LTC. Federal Medicaid statutes and regulations reflect both an institutional bias and an orientation toward a medical model of care (Har-rington et al., 2000). This bias is reflected in the Medicaid regulations that make nursing facilities a mandatory program entitlement, whereas home-and community-based services (HCBS) are optional services (Harrington et al., 2000). At their own discretion, states offer the following two Medicai