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Home and Community-Based PAS > Reports > Medicaid Home and Community-Based Services: Program Data, 1992-2001

Medicaid Home and Community-Based Services: Program Data, 1992-2001

Part 2

Medicaid 1915(c) HCBS Waivers: Program Data 1992 Through 2001

This section reports Medicaid 1915(c) HCBS waiver participants, expenditures, and service data for the period 1992 through 2001. Tables 1-3 report participant data, Tables 4-8 report expenditure data, and Table 9 reports the number, type and scope of waiver programs. Each of the Tables 1-9 has an ‘A’ and a ‘B’ format. The ‘A’ set report data by waiver and the ‘B’ set report data by state.

(a) Waiver Participants

Table 1A reports the annual (unduplicated) participants by waiver, for the period 1992 through 2001. Table 1B shows the annual (unduplicated) participants by state, for the period 1992 through 2001. At the national level, waiver participation rose from 235,580 persons in l992 to 832,915 in 2001, or by 254 percent. While the national total of participants increased by 13 percent in 1999, the growth rate fell to 10 percent in 2000² and remained constant at 8 percent in 2001.

Table 2A shows the annual waiver (unduplicated) participants per 1,000 population by waiver for the period 1992 through 2001. Table 2B shows the annual HCBS waiver (unduplicated) participants per 1,000 population by state, for the period 1992 through 2001. In 1992, there was a national average of 0.92 participants per 1,000 population. By 2001, this had increased by 217 percent to 2.92 participants per 1,000 population. The national growth rate of 6 percent in 2000 increased to 7 percent in 2001.

Table 3A reports the number of (duplicated) participants that used one of six services, by waiver, in 2001. Table 3B shows the number of (duplicated) participants that used one of six waiver services, by state, in 2001. Participants could use more than one service. When compared with 2000² (figures shown in parentheses) participation in each service except case management increased. In 2001, there were: 282,427 participants that used case management (287,248); 153,418 that used residential care/assisted living or foster care (122,377); 486,116 that used respite, home health, or personal care services (477,050); 254,831 that used habilitation or day care (248,976); 93,009 that used nursing or other therapy services (77,398); and 653,370 participants that used other services (524,218). These figures do not include participants on 24 waiver programs for which CMS 372 reports were not available.

Table 3C reports the number of waivers per state and the (unduplicated) participants by recipient type and state in 2001. Compared with the 155 waivers in operation in 1992, this study identified 229 waivers in operation in 2001. During this period, some states consolidated their total number of waivers while others expanded their total number of waivers. Compared with 2000, the national total of waiver programs increased by 3 in 2001.²

In 2001, the total number of waiver participants increased from the 2000 figure of 768,375,² to 832,915. When compared with 2000² (figures shown in parentheses) the number of each type of recipient except AIDS/ARC increased, to reach (in persons): MR/DD 322,266 (284,534); aged 95,356 (92,661); aged/disabled 348,787 (318,853); disabled and physically disabled 40,178 (36,653); special care children 4,554 (4,383); AIDS/ARC 13,822 (13,890); mental health 3,096 (2,494); and TBI/head injury 4,856 (3,189).

(b) Waiver Expenditures

Table 4A reports the annual waiver expenditures by waiver for the period l992 through 2001. Table 4B shows the annual HCBS waiver expenditures, by state, for the period l992 through 2001. Across the nation, total waiver expenditures increased from $2.16 billion in 1992 to $14.22 billion in 2001, or by 557 percent. After a fall in the rate of increase in total expenditure from 23 percent in 1999 to 10 percent in 2000,² the rate rose again in 2001 to 13 percent.

Table 5Areports the annual expenditures for each (unduplicated) participant, by waiver, for the period l992 through 2001. Table 5B shows the annual expenditures for each (unduplicated) participant, by state, for the period l992 through 2001. National average expenditures per waiver participant increased from $9,187 in 1992 to $17,070 in 2001, or by 86 percent. After a fall in the rate of expenditure growth from 9 percent in 1999 to 1 percent in 2000,² the annual growth rate rose again in 2001 to 4 percent.

Table 6A shows the annual expenditures per capita by waiver from 1992 through 2001. Table 6B shows the annual expenditures per capita by state for the period 1992 through 2001. Over this period, national waiver expenditures per capita rose from $8.48 in l992 to $49.92 in 2000, or by 489 percent. After a fall in the rate of expenditure per capita growth from 22 percent in 1999 to 6 percent in 2000,² the annual growth rate rose in 2001 to 12 percent.

Table 7A shows the total expenditures on each of the six service categories by waiver in 2001. Table 7B shows the total expenditures on each of the six service categories by state in 2001. When compared with 2000² (figures shown in parentheses) the expenditures on three service categories increased (residential/foster care, respite, and others) but three reduced (case management, nursing, and habilitation/day care). Specifically, compared with 2000, expenditures by service category were: case management, $453 million ($456 million); residential care/assisted living or foster care, $2,945 million ($1,918 million); respite, home health, or personal care services $3,129 million ($2,774 million); spent on habilitation or day care, $5,416 million ($5,612 million); nursing or other therapy services $230 million ($248 million); and other services, $960 million ($716 million).

Table 8A reports the expenditures per (duplicated) participant by service category and waiver in 2001. Table 8B shows the expenditures per (duplicated) participant by service category and state in 2001. When compared with 2000² (figures shown in parentheses) the expenditures per participant on four service categories increased (case management, residential/foster care, respite, others) and two reduced (habilitation/day care, nursing or other therapy services). Specifically, compared with 2000, expenditures per participant by service category were: case management, $1,606 ($1,591); residential care/assisted living or foster care $19,198 ($15,674); respite, home health, or personal care services $6,438 ($5,822); habilitation or day care, $21,256 ($22,539); nursing or other therapy services, $2,475 ($3,206); and, other services $1,469 ($1,367) per participant. These figures do not include the 24 waiver programs for which CMS 372 reports were not available.

Table 9A reports the expenditures by recipient type and state in 2001. When compared with 2000² (figures shown in parentheses) the expenditures on seven recipient types increased (aged/disabled, AIDS/ARC, special care children, disabled/physically disabled, mental health, MR/DD, and TBI/head injury), and one reduced (aged). Specifically, compared with 2000, expenditures by recipient type were: MR/DD $10.5 billion ($9.2 billion); aged, $407.7 million ($434.0 million); aged/disabled $2.4 billion ($2.1 billion); disabled/physically disabled $518.7 million ($434.5 million); special care children $88.9 million ($77.9 million); AIDS/ARC $56.9 million ($56.3 million); mental health $14.6 million ($11.2 million); and TBI/head injury, $134.7 million ($104.7 million).

Table 9B reports the expenditures per participant by recipient type and state in 2001. When compared with 2000² (figures shown in parentheses) the expenditures per participant on six recipient types increased (aged/disabled, AIDS/ARC, special care children, disabled/physically disabled, mental health, MR/DD), and two reduced (aged, TBI/head injury). Specifically, compared with 2000, the expenditures by eight recipient categories were: MR/DD $32,685 ($32,474); aged, $4,276 ($4,684); aged/disabled $6,862 ($6,462); disabled/physically disabled $12,911 ($11,853); special care children $19,511 ($17,769); AIDS/ARC $4,118 ($4,050); mental health $4,712 ($4,487); and TBI/head injury $27,734 ($32,823).