The Medicaid Home and Community-Based Waiver and Supported Employment

The Medicaid Home and Community-Based (HCB) Waiver is the primary funding source for long-term care for individuals with developmental disabilities. Findings from a national survey of 48 state coordinators regarding waiver-funded supported employment services are presented. Very low utilization for this service was found, primarily due to limits on eligibility. However, respondents in 18 states reported large numbers of waiver participants receiving employment services under other service categories. Eleven states had waiting lists for waiver-funded supported employment, totalling three times those actually receiving services. Low reimbursement rates to provider agencies and disinterest of providers in using waiver funds were significant barriers to expansion of service capacity.