Only respondents in Wisconsin felt that a philosophy favoring home care presented a barrier to serving Medicaid beneficiaries in residential care settings. They noted that many of the counties did not want to use public funding in residential care settings because they favored home care. One stated that many counties thought some CBRFs, particularly larger ones, were more like institutions. Given that the intent of the waiver program is to provide alternatives to institutions, some counties do not want to use limited funds in what they view as quasi-institutional settings. Others disagreed, saying that people living in residential care settings view that setting as their home and should be able to receive waiver services there if eligible.