Service Use and Unmet Needs Among Adults with Autism Awaiting Home- and Community-Based Medicaid Services.

Schott et al. (2021) asked autistic adults on Medicaid waiver waitlists what services they actually get. They used a survey. The team wanted to know which needs stay unmet while people wait.

The survey covered everyday living skills, job help, and mental-health care. It also tracked who gets less: African American, Hispanic, and over-21 adults.

Two-thirds of the adults still lacked help with daily skills, work, or mental health. Even though all were approved for future waiver slots, most got nothing during the wait.

Black and Hispanic adults, plus anyone over 21, received even fewer services. The gap was largest for vocational and mental-health supports.

Tint et al. (2018) extends these numbers with stories. Women with autism in their qualitative study said providers often ignored them. Together, the two papers show the same unmet needs from two angles: numbers and voices.

Friedman (2017) and Friedman (2018) looked inside the same waiver system. They found most states allow self-direction, yet spend almost zero dollars on it. Whitney’s finding—people get nothing while waiting—lines up: if states won’t fund choice, they probably won’t fund basic services either.

Saloner et al. (2019) seems to disagree. Their study showed Kansas kids doubled service use after an insurance mandate. But the kids had private insurance; Whitney’s adults rely on Medicaid waivers. Different payer, different gate—no real contradiction.

If you write waiver plans, flag functional skills, vocational, and mental-health goals first. These three areas are the biggest holes. When a slot finally opens, you can paste in goals that are already written and waiting. Also track race and age: if the team is about to age-out a client at 21, push the paperwork now so they don’t fall into the same service gap.