NAPAS is pleased to offer Medicaid Waivers, Tools For Deinstitutionalization: Innovative Models And Legal Strategies. This paper is intended to: (1) Demonstrate the flexibility of waivers to promote deinstitutionalization; (2) identify the limitations of waivers; (3) describe a few waivers that provide community-based services to disability populations for which waivers are not as frequently utilized; and (4) discuss some of the legal issues surrounding waivers. With this knowledge, advocates will be able to better press both formally and informally for the development of appropriate community-based systems of support.

 

Table of Contents

 

1.                  BASIC WAIVERS

 

A. Services Available Under a Home and Community-Based Service Waiver

B. Waivers as Alternatives to Services in a Hospital, Nursing Facility or ICF/MR

C. Waivers of Statewideness, Comparability of Services, and Income and Resource Rules

D. Cost Neutrality and Numbers Caps

 

2.                  UTILIZATION CONTROL RESTRICTIONS

 

3.                  DUPLICATION OF STATE PLAN SERVICES

 

4.                  FLEXIBILITY OF WAIVERS

 

A. HCFA Efforts to Promote the Creation of More Community-Based Service

B. Unique Waiver Services Developed by States for Particular Populations

 

5.                  WRAPAROUND SERVICES FOR CHILDREN

 

6.                  LEGAL ISSUES SUBJECT TO LITIGATION

 

A. Cases Applying Medicaid Mandates to HCBS Waivers

B. Changes in Waivers in Response to Litigation

 

Appendix I: State Limits Imposed Under the Medicaid Home Health Benefit

Appendix II: State Limits Imposed Under the Medicaid PCS Benefit

 

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