Medicaid Managed Care - U.S. Senate Special Committee on Aging

States Use Waivers to
Expand and Change
Programs for
Developmentally
Disabled
States Serve More People
and Shift Balance by
Serving More in Waiver
Than in ICF/MR Program
D-HESI0
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program. These services include federally mandated services, such as
home health cam, and other services that states may elect to provide,
which are called optional services. Some of the more important optional
services for the population with developmental disabilities are
rehabilitative services,' case management, and personal care. Because the
regular <strong>Medicaid</strong> program operates as an entitlement-that is, all eligible
individuals in a state are entitled to receive all services offered by the
state-states have less control over utilization and the cost of services
than in waiver programs.
Through the use of waivers, states have changed long-term care nationally
for persons with developmental disabilities in two ways. First, states have
significantly expanded the number of individuals being served. Second,
states have shifted the program balance from serving most people through
the icF/MR program to serving most through the waiver program. Generally
the shift to the waiver program has been part of an evolution of services
away from large and more restrictive settings to providing services in
small and less restrictive settings, which are preferred by recipients and
their families. Some state waiver programs are continuing to evolve from
their earlier approach of providing services primarily in group home
settings to one of serving people at home.
From 1990 to 1995 the number of persons served by the waiver and ICFfmR
programs combined rese at an average annual rate of 8 percent (see table
1). The number served by the waiver program more than tripled to over
142,000 persons during this period and accounted for the entire increase in
the number of persons served by both programs. States dramatically
increased the number of people who received waiver program services
using a variety of strategies, including substituting waiver program for
IcFmR program services, services provided under state-only programs, and
services to persons who were not being served before.
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