Home- and community-based waivers for children with autism: effects on service use and costs

Intellect Dev Disabil. 2014 Aug;52(4):239-48. doi: 10.1352/1934-9556-52.4.239.


We examined (a) the associations between Medicaid home and community-based waiver participation and service use and expenditures among children with ASD; and (b) how states' waiver spending moderates these effects. We used 2005 Medicaid claims to identify a sample of children with autism spectrum disorder (ASD). We selected two comparison groups who had no waiver participation: (a) children who were eligible for Medicaid through disability (disability group), and (b) children who had at least one inpatient/long-term care (IP/LT) episode (IP/LT group). Waiver participants were less likely to use IP/LT services and had lower associated expenditures than the disability group. As states' waiver spending increased, waiver participants became increasingly less likely to use IP/LT services. Waiver participants had more outpatient visits and associated expenditures; this difference increased as state waiver spending increased. Compared with the IP/LT group, waiver participants had lower IP/LT expenditures, more outpatient visits, and associated expenditures. Higher state waiver generosity increased this effect on outpatient visits and expenditures.

Keywords: Autism spectrum disorder; Medicaid; home- and community-based waivers; inpatient/long-term care; outpatient care.

MeSH terms

  • Adolescent
  • Autistic Disorder / economics*
  • Child
  • Female
  • Health Care Costs*
  • Health Expenditures
  • Home Care Services / economics*
  • Home Care Services / statistics & numerical data
  • Humans
  • Long-Term Care / economics
  • Male
  • Medicaid / economics*
  • United States