Developing home and community-based service (HCBS) alternatives to institutional care has been a priority for many state Medicaid programs over the last two decades. In 2005, overall spending on Medicaid HCBS increased 10 percent, with 2.8 million individuals being served through these programs. This report presents a summary of the main trends to emerge for the three Medicaid HCBS programs and the results of a survey of policies such as eligibility criteria and waiting lists.