Met and unmet need for Medicaid home- and community-based services in the states

This study examined the met and unmet need for Medicaid personal care services (PCS) and home- and community-based service (HCBS) waivers across the states. Medicaid directors and state officials working with PCS and HCBS were interviewed by telephone in 1998-1999 to collect descriptive and statistical data. A total of 26 states offered PCS to 467,487 participants in 1998-1999, and 49 states offered waiver services to 561,510 participants in 1997. In spite of wide variations in total HCBS participants per capita, 42 states reported inadequate waiver slots and waiting lists. Even in states with the highest participant rate per capita, state officials reported waiting lists for the HCBS waiver program and many target groups that were not adequately covered by the current HCBS waivers. A number of barriers existed to expanding HCBS services, including an inadequate supply of home- and community-based providers, limited state legislative support for the programs, and federal regulatory barriers such as restrictions on need criteria.