Home- and community-based waivers for children with autism: effects on service use and costs.
Higher state spending on Medicaid HCBS waivers cuts institutional care and boosts outpatient services for kids with autism.
01Research in Context
What this study did
Cidav et al. (2014) looked at Medicaid home- and community-based waivers for kids with autism.
They compared states that spent a lot on these waivers with states that spent less.
The team checked whether kids used fewer hospitals and more outpatient visits after getting waiver slots.
What they found
States that poured more money into waivers saw big drops in pricey inpatient and long-term care.
At the same time, kids in those states used more outpatient therapy and community services.
Bottom line: higher waiver spending moved care out of hospitals and into homes and clinics.
How this fits with other research
Eskow et al. (2015) echo the good news. They tracked families who got waiver-funded ABA at home and saw stronger daily-living skills and happier families than kids stuck on a wait list.
Eskow et al. (2019) go one step further. They show the gains get even larger when families can pick their own providers and control the daily schedule.
Reyer et al. (2006) paints the earlier picture: before waivers, kids with autism cost Medicaid ten times more than typical kids, mostly from psychiatric hospital stays. Zuleyha’s findings flip that cost driver on its head.
Goodwin et al. (2012) add the parent view: states that spend more on disability services leave families with lighter out-of-pocket bills, matching the cost-shift Zuleyha found.
Why it matters
If you write waiver plans or fight for funding, wave this paper. It gives hard numbers showing every extra waiver dollar replaces about the same amount in hospital days.
Use the data to tell state officials that boosting waiver slots is not just kinder—it’s cheaper.
Pair the message with Goldrich’s choice findings: ask for both more money AND more family control. That combo cuts costs and lifts outcomes at the same time.
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Join Free →Pull your state’s latest waiver allocation report and flag the line for long-term care—prepare one slide showing how shifting those dollars to HCBS slots can save money while keeping kids at home.
02At a glance
03Original abstract
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.
Intellectual and developmental disabilities, 2014 · doi:10.1097/00001199-200102000-00007