Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Target Population


When determining which population to serve in residential care settings, states need to consider their policy goals and their current long-term care system. Questions to ask include the following: Is the new coverage intended to fill a gap in the current set of options? Will the target population be different from the population usually served in the state’s residential care facilities? Is the new coverage intended to enable people who cannot be served in their homes to avoid institutionalization?

Once these questions are answered, the state must decide which age groups will be served--those age 65 or older or younger adults with physical disabilities, or both--and whether services will be designed to address the specialized needs of specific populations, for example, persons with dementia or individuals with acquired brain injuries. It is crucial to make certain that the state’s licensing and other facility regulations match the needs of the target population. As noted above, if the state wants to target nursing home-eligible beneficiaries, the facilities need to be licensed or certified to serve a population with a nursing home level of need.

When determining the target population for an HCBS waiver serving individuals with developmental disabilities, states may combine the entire eligible population into one HCBS waiver, or may choose to craft “specialty” waivers that target specific populations, such as children or individuals with autism. At least seven states have separate HCBS waivers serving individuals with autism. States may choose to target waivers to specific sub-groups within a larger population of eligible individuals as a means to offer specialized and/or different services to the sub-groups. The choice to use multiple waivers targeting distinct sets of eligible individuals is of course related to state policy goals.

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