Performance Improvement 2008. How Have States Sought to Save Money and Serve More People with Intellectual and Developmental Disabilities through "Supports" Waivers?


This study examined up-close what states were doing to expand supports waivers and their reasons for doing so. Increasingly, States are moving to scaled back "supports" waivers for people with intellectual and developmental disabilities and away from more "comprehensive" waivers as a way to control costs, increase the role of informal caregivers, enhance consumer direction, and leverage limited funding. Supports waivers are characterized by a relatively low dollar cap on the total amount of home and community-based services (HCBS) waivers that may be authorized on behalf of a beneficiary, flexibility in the selection of services within the dollar cap, and the expectation that unpaid family caregivers will provide significant support to waiver participants.

In 2006, there were 19 supports waivers operating in 17 States. These waivers were operating in tandem with comprehensive HCBS waivers for people with intellectual and developmental disabilities. Two additional States had applications pending. Of the 21 supports waivers, three targeted children, seven targeted adults and 11 targeted both children and adults. Funding limits ranged from $5,000 to $52,000 per year, most in the range of $13,000-$20,000. Supports waiver costs per participant were 30 percent of the comprehensive waiver costs. Fifteen of the 17 supports waiver States applied annual per participant caps. Total supports waiver enrollment increased by 66 percent between 2000 and 2006 and enrollment in comprehensive waivers grew by 31 percent. Enrollment in supports waivers accounted for 56 percent of total enrollment growth. By 2006, 26 percent of all waiver participants in these states were expected to be enrolled in supports waivers.

Emphasizing supports waivers slowed the growth of comprehensive waiver services and stabilized per participant costs of furnishing waiver services. The implementation of supports waivers permitted most of the States to offer more HCBS waivers, at least for people with intellectual and developmental disabilities, by de-emphasizing the delivery of costly residential services. Using supports waivers, States innovated and acted flexibly in their waiver programs, responding to changing consumer and family expectations.

Report Title: Gauging the Use of HCBS Support Waivers for People with Intellectual and Developmental Disabilities: Profiles of State Supports Waivers;
Agency Sponsor: ASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: Susan Polniaszek, 202-690-6443
Research Triangle Institute
PIC ID: 8655

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"PerformanceImprovement2008.pdf" (pdf, 1.29Mb)

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