Medicaid 1915(c) Home- and Community-Based Services waivers for children with autism spectrum disorder.
Medicaid autism waivers are a messy patchwork—check your state’s list of covered services before you promise anything to families.
01Research in Context
What this study did
The authors read every Medicaid 1915(c) waiver for kids with autism in the United States.
They found 50 waivers spread across 29 states and wrote down what each one pays for.
No kids were tested; this is a simple map of what services states say they will cover.
What they found
Every waiver looks different. One state may pay for 30 hours of ABA, another pays for respite only.
No two states use the same list of benefits, limits, or age rules.
The paper gives a table you can scan to see if your state’s waiver includes the service you need.
How this fits with other research
Bigby et al. (2009) already showed that family-support dollars vary ten-fold across states. Tonnsen et al. (2016) now show the same chaos inside autism-specific waivers.
Rivera-Figueroa et al. (2025) add that racial and income gaps still shape who actually uses the services, even when a waiver exists. Together the three papers say: coverage on paper ≠ access in real life.
McCauley et al. (2018) looked at autistic adults and found high mental-health medication use. Their numbers warn that kids who age out of these uneven waivers may land in another patchwork system.
Why it matters
Before you write a treatment plan, open your state’s waiver page and check the fine print. If ABA hours are capped at 20, you will need a different funding source for the other 10. Share the waiver table with families so they can advocate early and avoid surprise denials.
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02At a glance
03Original abstract
This research aims to describe the characteristics of 1915(c) Home- and Community-Based Services waivers for children with autism spectrum disorder across states and over time. While increasingly popular, little is known about these Medicaid waivers. Understanding the characteristics of these programs is important to clinicians and policymakers in designing programs to meet the needs of this vulnerable population and to set the stage for evaluating changes that occur with the implementation of health-care reform. Home- and Community-Based Services waiver applications that included children with autism spectrum disorder as a target population were collected from the Centers for Medicare and Medicaid Services website, state websites, and state administrators. A data extraction tool was used to document waiver inclusions and restrictions, estimated service provision and institutional costs, and the inclusion of four core autism spectrum disorder services: respite, caregiver support and training, personal care, and evidence-based treatments. Investigators identified 50 current or former waivers across 29 states that explicitly included children with autism spectrum disorder in their target populations. Waivers differed substantially across states in the type and breadth of autism spectrum disorder coverage provided. Specifically, waivers varied in the populations they targeted, estimated cost of services, cost control methods employed, and services offered to children with autism spectrum disorder. Home- and Community-Based Services waivers for children with autism spectrum disorder are very complex and are not consistent across states or over time. Further efforts are needed to examine the characteristics of programs that are associated with improved access to care and clinical outcomes to maximize the benefits to individuals with autism spectrum disorder and their families.
Autism : the international journal of research and practice, 2016 · doi:10.1177/1362361315590806