Medicaid Section 1915(c) Waiver Programs Annual Expenditures and Beneficiaries Report: Analysis of CMS 372 Annual Reports, 2018–2019
Long-term Services and Supports Expenditure Reports Project
Prepared for:
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Center for Medicaid and CHIP Services
- Section 1915(c) waiver programs comprise an important component of LTSS delivery systems for most states.
- Nationally, about 1.9 million beneficiaries participated in section 1915(c) waiver programs in 2019, representing a 5.2 percent increase from the prior year.
- Similar to observed increases in participation from 2018 to 2019, average waiver program and total Medicaid (waiver and non-waiver program) expenditures per participant also increased during this time period. In 2018, average section 1915(c) waiver program expenditures per participant per year were $29,743, and, in 2019, they were $30,063.
- As in previous years, there was considerable variation in section 1915(c) waiver program participation, service use, and expenditures in 2019 across the various long-term services and supports (LTSS) target group populations.
Section 1915(c) of the Social Security Act enlarged the scope of the Medicaid program to allow for the provision of comprehensive long-term care services in home- and community- based settings as an alternative to institutional care. Introduced as part of the Omnibus Budget Reconciliation Act of 1981, state use of section 1915(c) waiver programs grew slowly but steadily. Over the past several decades, states have used section 1915(c) waiver programs, several other federal authorities, and federally funded grant programs to develop a broad range of home and community-based services (HCBS) to provide alternatives to institutionalization for eligible Medicaid beneficiaries. States vary markedly in the types of section 1915(c) waiver programs offered. This is the ninth report sponsored by the Centers for Medicare & Medicaid Services (CMS) that uses information from annual CMS 372 report submissions to present national and state-level trends in section 1915(c) waiver program participants, service use, and expenditures for 2019 and changes from prior years. The accompanying Excel attachment contains section 1915(c) waiver program expenditures and participation data for 2018 and 2019, as well as state rankings by expenditures and waiver program participation for 2019.
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