Medicaid Section 1915(c) Waiver Programs Annual Expenditures and Beneficiaries Report, 2017-2018
- Section 1915(c) waiver programs comprise an important component of LTSS delivery systems for most states.
- Nationally, about 1.8 million beneficiaries participated in 267 section 1915(c) waiver programs offered by 47 states in 2018, representing a 4.9 percent increase in participants from 2017.
- Similar to observed increases in participation from 2017 to 2018, average waiver program and total Medicaid (waiver and non-waiver program) expenditures per participant also increased during this time period. In 2017, average section 1915(c) waiver program expenditures per participant per year were $28,044, and in 2018, they were $29,453.
- As in previous years, there was considerable variation in section 1915(c) waiver program participation, service use, and expenditures in 2018 across the various long-term services and supports (LTSS) target group populations.
Section 1915(c) of the Social Security Act enlarged the scope of the Medicaid program to allow for the provision of comprehensive long-term care services in home- and community- based settings as an alternative to institutional care. Introduced as part of the Omnibus Budget Reconciliation Act of 1981, state use of section 1915(c) waiver programs grew slowly but steadily. Over the past several decades, states have used section 1915(c) waiver programs, several other federal authorities, and federally funded grant programs to develop a broad range of home and community-based services (HCBS) to provide alternatives to institutionalization for eligible Medicaid beneficiaries. States vary markedly in the types of section 1915(c) waiver programs offered. This is the eighth report sponsored by the Centers for Medicare & Medicaid Services (CMS) that uses information from annual CMS 372 report submissions to present national and state-level trends in section 1915(c) waiver program participants, service use, and expenditures for 2018 and changes from prior years. The accompanying Excel attachment contains section 1915(c) waiver program expenditures and participation data for 2017 and 2018, as well as state rankings by expenditures and waiver program participation for 2018.