A National Analysis of Medicaid Home and Community Based Services Waivers for People With Intellectual and Developmental Disabilities: FY 2015.

Friedman (2017) looked at every state’s Medicaid HCBS waiver plan for people with IDD in 2015.

The team counted how much money each state asked for and what services the dollars were meant to buy.

Residential habilitation and day habilitation grabbed the biggest slices of the pie in almost every state.

Yet the size of the pie and the way it was cut varied sharply from one state to the next.

Friedman (2023) supersedes these 2015 numbers by showing the same pattern six years later, only with bigger totals: $43 billion for 861,000 people versus $25 billion for 630,000.

Friedman et al. (2015) extends the picture by zooming in on mental-health line items from the same 2015 waivers; it finds those services are routinely under-funded and uneven across states.

Lakin et al. (2010) sets the stage by tracking the decade before, confirming the steady shift of Medicaid dollars out of institutions and into HCBS, which explains why residential and day hab now dominate the budget.

If you write behavior plans for adults or children with IDD, know that most waiver dollars flow to living supports and day programs, not to one-to-one ABA therapy.

Check your state’s waiver line items before you budget for extra staff or request authorizations; funding patterns in the next state may not match yours.