States may operate several different HCBS 1915c waiver programs, each designed to target different groups of people based on age, diagnosis, or condition. States may also receive a waiver of Medicaids statewideness requirements and offer some HCBS waiver services in a particular jurisdiction or region of the state or operate statewide but set a cap on the number of people who may enroll in a waiver program. HCBS 1915c waiver programs are intended to serve people who would otherwise need and be eligible to receive care in a nursing home or institutional setting.
In many states, a significant number of non-elderly people with disabilities, often adults with SMI, are in nursing homes.29 Many states are working to provide supportive housing as an alternative to nursing home care. These efforts have two potential motives: (1) to reduce Medicaid spending for long-term care; and (2) to comply with requirements to offer people with disabilities the opportunity to live in integrated settings in the community, consistent with the requirements of the Americans with Disabilities Act and the U.S. Supreme Courts 1999 Olmstead decision.