Long-term Services and Supports Expenditure Reports Project
Prepared for:
U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Center for Medicaid and CHIP Services
Medicaid Section 1915(c) Waiver Programs Annual Expenditures and Beneficiaries Report, 2015-2017
Associated Project
Key Findings
- Section 1915(c) waiver programs comprise an important component of long-term services and supports (LTSS) delivery systems for most states.
- The national total number of section 1915(c) waiver program participants declined slightly from 2016 to 2017, from 1.68 million waiver program participants to 1.66 million (a 1.4 percent decline).
- While participation decreased in 2017 relative to 2016, average waiver program and total Medicaid (waiver and non-waiver program) expenditures per participant increased during this time period. In 2016, average section 1915(c) waiver program expenditures per participant per year were $27,380, while in 2017 they were $29,279.
- There was considerable variation in section 1915(c) waiver program participation, service use, and expenditures in 2016 and 2017 across the various 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 seventh 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 2016 and 2017 and changes from prior years. The accompanying Excel attachment contains section 1915(c) waiver program expenditures and participation data for 2015, 2016, and 2017, as well as state rankings by expenditures and waiver program participation for 2016 and 2017.
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