Mental/Behavioral Health Services: Medicaid Home and Community-Based Services 1915(c) Waiver Allocation for People With Intellectual and Developmental Disabilities.

Friedman et al. (2015) read every 1915(c) waiver application that states filed for people with intellectual and developmental disabilities. They pulled out the dollars listed for mental and behavioral health services. The team compared states to see who budgeted what.

The survey looked at the same fiscal year as Friedman (2017), so the two papers share one data set. The 2015 paper zooms in only on mental-health lines; the 2017 paper counts every waiver dollar.

Some states set aside generous chunks of waiver money for counseling, behavior support, and crisis help. Others put in almost nothing. The authors call the gap 'large interstate variance.' Overall, mental-health lines were routinely underfunded.

Friedman et al. (2025) is the direct sequel. Same survey method, but ten years later and nationwide. It shows the split grew: nearly one billion waiver dollars now go to mental-health or crisis services for 190,299 people with IDD, yet state ranks still swing from high to low.

Friedman (2017) used the full 2015 waiver census and found residential and day habilitation eating most funds. Together the two papers reveal a trade-off: when housing and day programs grab the biggest slices, behavioral-health slices stay thin.

Lakin et al. (2010) tracked the decade before 2015 and showed Medicaid rushing out of institutions into HCBS. That shift raised total spending but lowered per-person spending, setting the stage for the tight mental-health budgets Friedman et al. (2015) uncovered.

If you write behavior plans or seek prior authorization, you now know the pot of money is smaller in some states through no fault of your client. Use the 2015 and 2025 papers side by side: show administrators that peers in other states fund crisis respite, mobile therapy, and ABA at higher rates. Frame your next budget request as catching up, not asking for extras.