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Analysis of Home and Community-Based Care Medicaid Waiver Services Among Children with Medical Complexity

Organization: University of Virginia

Primary Contact: Jessica Keim-Malpass

Grant Amount: $119,177 for 18 months

Date Awarded:

Date Completed:

Purpose

To describe and compare the key features of states’ Home and Community-Based Service Medicaid Waivers

Outcome

Children with medical complexity make up less than 1 percent of all US children, but account for a high percentage of pediatric health care costs. Much of the care for children with medical complexity is delivered in home- and community-based settings and is covered by Medicaid waivers, which allow states flexibility in the services and populations they cover. These waivers often increase state expenditures, but their effectiveness and variability has not been studied.
 
As part of this project, researchers conducted an analysis of the coverage offered by the waivers and an evaluation of how states are using the waivers to support children with medical complexity. Three articles were produced from this work. The first described development of a systematic and reproducible approach to evaluate these Medicaid waivers. The second, published in Health Affairs, was, to the authors’ knowledge, the first to document a systematic evaluation of Medicaid waivers targeting children with medical complexity. The authors found significant variability in how states choose to interpret scope of coverage and services offered. The third article investigates how waivers are being used to cover services for children and youth with mental health care needs.

 

Related Resources

In many states, home and community-based services are covered for children with medical complexity through Medicaid waivers. Authors of the article developed a systematic and reproducible approach to evaluate the waivers for overall coverage of children with medical complexity in different states.

Many children with medical complexity receive care in home and community-based settings. These services may be covered using Medicaid waivers. Authors of the article evaluated how states use these waivers to provide coverage to children with medical complexity and determine services offered. The findings indicate great variability in how states interpret scope of coverage and services and how this variability could impact child and family outcomes.

Many states cover mental health home and community‐based services (HCBS) for youth through Medicaid waivers. Authors of the article evaluated how states are covering mental health services using Medicaid waivers and compared this to waivers being used to cover services for other pediatric conditions. The findings indicate broad variability in waiver eligibility, transition plans, services covered, and waitlists across populations of youth covered by waivers.