Twenty-Five Years of Medicaid Home and Community Based Services (HCBS): Significant Milestones Reached in 2007

摘要

The Medicaid Home and Community Based Services (HCBS) program was authorized on August 13, 1981. It permitted the Secretary of Health and Human Services to waive certain Medicaid requirements so that states could receive federal Medicaid cost-share for “noninstitutional” services for Medicaid-eligible individuals who, without HCBS services, would remain in or be at a risk of being placed in a Medicaid nursing facility or Intermediate Care Facility for persons with Mental Retardation (ICF/MR). The Medicaid HCBS waiver program permits states to provide a wide variety of community services to people with intellectual and developmental disabilities, including service coordination, in-home supports, vocational and day services, respite care, and other services, to reduce the use of and per person expenditures for ICFs/MR. Fiscal Year (FY) 1982 was the first year in which states could apply to use the new HCBS option. At the end of state FY 1982 (June 30, 1982), only two states (Montana and Oregon) offered HCBS to persons with intellectual and developmental disabilities, with only 1,381 total service recipients. From those 1,381 persons and $2.9 million in total FY 1982 expenditures, by the end of FY 1992, the HCBS program grew to 62,429 recipients and $294 million in expenditures. In that first decade of the program, HCBS program growth was substantially restricted by regulatory requirements that states demonstrate reductions in projected ICF/MR use and expenditures roughly equal to the requested increases in HCBS participants and expenditures.