Medicaid home- and community-based services (HCBS) allow people with significant physical and cognitive limitations to remain in their homes or home-like settings rather than in an institution. States can cover HCBS in their state plans or through various waiver authorities targeted to certain populations. Waivers under Section 1915(c) and Section 1115 of the Social Security Act are often used by states to cover HCBS and permit states to limit the number of individuals served and establish waiting lists.
MACPAC compiled selected information on waiver capacity and waiting list management in a Compendium of Medicaid Home- and Community-Based Services Waiver Waiting List Administration, and we describe the results of our analyses of these waivers in this issue brief (MACPAC 2020). We also conducted stakeholder interviews to gain insight on state approaches to waiting list management, strategies to reduce waiting lists, and the experiences of individuals on waiting lists. We found that although waiting lists are often cited as an indicator of unmet need for Medicaid-covered HCBS, they are an imperfect proxy. Our interviews, however, suggested a growing need for HCBS, and waiting list enrollment as a signal that state capacity is insufficient.