Home and Community Based Services (HCBS) waivers: a nationwide study of the states.
This paper is the first national phonebook of Medicaid waiver services for people with IDD—use it to see what your state will and will not pay for.
01Research in Context
What this study did
Peters et al. (2013) read every Home and Community Based Services waiver application. They looked at 88 plans from 41 states plus Washington, DC.
The team listed every service states promised to fund for people with intellectual or developmental disabilities. No trials, no treatment—just a national catalog.
What they found
Residential habilitation and day programs topped every list. Beyond that, the menus looked like patchwork quilts—no two states matched.
Some waivers paid for behavior supports, others for respite, others for job coaches. The paper gives you the full shopping list for each state.
How this fits with other research
Friedman (2017) and Friedman (2023) ran the same tally for later years. They show the same big-ticket items—residential and day habilitation—while total spending more than doubled.
Friedman et al. (2025) zoomed in on mental-health dollars. They found nearly one billion set aside for ABA and crisis services, proving waivers can fund behavior-analytic care even though Peters et al. (2013) barely mentioned it.
Lakin et al. (2010) adds historical context: between 1998 and 2008 Medicaid moved money out of large institutions and into these same HCBS waivers, setting the stage for the 2013 snapshot.
Why it matters
If you write behavior plans for adults or children with IDD, this map tells you which services your state already covers. Use the list when you justify ABA, respite, or supported employment in treatment plans. Check the later Carli updates to see funding trends you can cite in budget requests.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Open your state’s waiver application, find the line that lists “behavioral supports,” and quote it when you submit your next prior authorization.
02At a glance
03Original abstract
In fiscal year (FY) 2009, the Medicaid program funded over 75% of all publicly funded long-term supports and services (LTSS) for individuals with intellectual and developmental disabilities (IDD) in the United States ( Braddock et al., 2011 ). The majority of spending was attributed to the Home and Community Based Services (HCBS) Waiver program. In FY 2009, federal-state spending for the HCBS Waiver program reached over $25.1 billion and constituted almost half of total funding across the nation that year ( Braddock et al., 2011 ). Considerable effort has been spent investigating Medicaid program expenditures, however, due in part to the unique and state-specific nature of HCBS programs, national-level analysis on the types of services offered to individuals with IDD has not been available. A full understanding of the supports available through the Medicaid program is critical as the United States considers strategies for economic recovery among competing state and federal budget priorities. This article presents the results of an analysis of 88 Medicaid HCBS Section 1915(c) waiver applications for individuals with intellectual and developmental disabilities in 41 states and the District of Columbia. It analyzes IDD data and trends close to the real time intent of states and empowers advocates in presenting timely solutions to real-time issues.
Intellectual and developmental disabilities, 2013 · doi:10.1352/1934-9556-51.01.001