Oversight of Quality of Care in Medicaid Home and Community-Based Services: Waiver Programs.

摘要

In recent years, States have altered their approach to providing Medicaid-funded long-term care services. Rather than providing the majority of that care in institutions--such as nursing homes--States are now providing more care in homes and other community-based settings. States most often provide this care through 1915(c) HCBS waiver programs, and the individuals served by these programs are most commonly disabled and over age 65. In fiscal year 2010, Medicaid expenditures for HCBS waiver programs serving this population totaled an estimated $8.9 billion. Strong oversight of waiver programs is critical to ensuring the quality of care provided to beneficiaries. The beneficiaries served by these programs are among Medicaid's most vulnerable, and the nature of these programs puts beneficiaries at particular risk of receiving inadequate care. Some programs allow beneficiaries to be cared for by individuals with limited professional training, such as family members and neighbors. In addition, beneficiaries may receive care in their homes, isolated from observers who might detect and prevent abuse or mistreatment.