Medicaid Home Care Waivers for Persons with HIV/AIDS: Program Expenditures, Participants and Policies

In 2002, there were an estimated 1.3 million persons living with HIV/AIDS in the U.S. with 40,000 new infections reported annually. Among publicly funded programs, Medicaid was the largest public payer of HIV/AIDS care with $9.3 billion spent in 2004. Since 1985, states have had the option of providing Medicaid long-term care services to eligible persons with HIV/AIDS through the 1915(c) home and community-based service (HCBS) waiver program. While it is known that annual Medicaid HCBS waiver expenditures and participants continued to grow through the early 2000s, albeit unevenly between states and programs, little is known about recent trends in waivers targeted to persons living with HIV/AIDS. This paper provides analyses of the most recent and comprehensive available data on national program data for all Medicaid HIV/AIDS waivers for the period 1992-2002, the results of a national survey of policies used on these waivers in 2002, and a comparison of the costs of serving persons with HIV/AIDS in institutions and in waiver programs. Among the significant results is the general decline in the number of HIV/AIDS waivers, participation rates on waivers and large numbers of unused waiver slots. Discussions with state officials also revealed that new treatment options have reduced effective demand for HIV/AIDS waiver services. Finally, the results indicate that even with stringent cost control requirements on many waivers, national public estimated cost savings on waivers compared to institutional care for persons living with HIV/AIDS was $155 million in 2002