Key State Policy Choices About Medicaid Home and Community-Based Services

Appendix Table 1: State Adoption of Medicaid HCBS by Authority, FY 2018

Appendix Table 2: State Policy Choices About Medicaid Home Health State Plan Benefits, FY 2018

Appendix Table 3: State Policy Choices About Medicaid Personal Care State Plan Benefits, FY 2018

Appendix Table 4: Section 1915 (i) State Plan Services by State and Target Population, FY 2018

Appendix Table 5: Section 1915 (c) HCBS Waivers by Target Population, FY 2018

Appendix Table 6: Section 1115 HCBS Waivers by Target Population, FY 2018

Appendix Table 7: State Financial Eligibility Criteria for Medicaid HCBS Waivers by Target Population, FY 2018

Appendix Table 8: State HCBS Waiver Self-Direction and Provider Policy Choices, FY 2018

Appendix Table 9: Medicaid HCBS Waiver Waiting List Enrollment, by Target Population and by State, FY 2018

Appendix Table 10: Medicaid HCBS Waiver Waiting List Enrollment Change, FY 2017 to FY 2018

Appendix Table 11: Average Wait Time by Population for Medicaid HCBS Waivers with Waiting Lists, FY 2018

Appendix Table 12: State HCBS Waiver Utilization Control, Quality Measure, and Ombuds Policy Choices, FY 2018

Appendix Table 13: State Capitated MLTSS Policy Choices, FY 2018

Appendix Table 14: State Policy Choices About Electronic Visit Verification, FY 2018

Appendix Table 15: State Policy Choices About HCBS Settings Rule, FY 2018

Appendix Table 16: State Policy Choices About Direct Care Worker Minimum Wage and Overtime, FY 2018

Appendix Table 1: State Adoption of Medicaid HCBS by Authority, FY 2018
State State Plan Services Waivers
Home health Personal care Community First Choice Section 1915 (i) Section 1915 (c) Section 1115*
Alabama X X
Alaska X X X
Arizona X X
Arkansas X X ^ X
California X X X X X X
Colorado X X X
Connecticut X X X X
Delaware X X X X
DC X X X X
Florida X X X
Georgia X X
Hawaii X X X
Idaho X X X X
Illinois X X
Indiana X X X
Iowa X X X
Kansas X X** X
Kentucky X X
Louisiana X X X
Maine X X X
Maryland X X X X
Massachusetts X X X
Michigan X X ^ X
Minnesota X X X
Mississippi X X X
Missouri X X X
Montana X X X X
Nebraska X X X
Nevada X X X X
New Hampshire X X X
New Jersey X X X X
New Mexico X X** X X
New York X X X X X
North Carolina X X X
North Dakota X X X
Ohio X X X
Oklahoma X X X
Oregon X X X X
Pennsylvania X X
Rhode Island X X X
South Carolina X X
South Dakota X X X
Tennessee X X X
Texas X X X X X X
Utah X X X
Vermont X X X
Virginia X X
Washington X X X X X
West Virginia X X X
Wisconsin X X X
Wyoming X X
TOTAL
(51 states):
51 states 34 states 8 states 11 states 48 states 12 states
NOTES: *Includes states with § 1115 waivers without any accompanying § 1915 (c) waivers. **KS and NM deliver personal care state plan services through their Section 1115 capitated managed care waivers and do not separately report on state plan personal care enrollment, spending, or program policies. ^AR began covering § 1915 (i) services in March 2019, and MI began covering § 1915 (i) services in Oct. 2018.
Appendix Table 2: State Policy Choices About Medicaid Home Health State Plan Benefits, FY 2018
State Optional Therapy Services^ Assistance with Household Activities Self-Direction Utilization Controls
Provider Reimbursement Rates
(per visit, unless noted as per hour)
Copay
Cost Cap Hour Cap Agency Registered Nurse Home Health Aide
Alabama X X $27.00 $27.00 $27.00
Alaska X X $269.54
Arizona X X X $124.74 $105.69 $46.81
Arkansas X $145.02 $66.63
California X X X $1/visit $74.86 $45.75
Colorado X X $144.54 $ 146.92 $148.12
Connecticut X X* $95.20 $   6.16
Delaware X X* NR
DC X X $60.00 $90.00 $20.20/hr
Florida X X $2/day $31.04 $17.46
Georgia X X $3/visit $61.32 $61.32 $61.32
Hawaii X $124.00
Idaho X X* $167.96 $58.91
Illinois X $72.00 $72.00 $72.00
Indiana X $ 231.00
Iowa X X* $130.17 $121.33 $54.94
Kansas X $3/visit** $50.00 $80.00 $40.50
Kentucky X $3/visit $69.47 $87.15 $34.13
Louisiana X $147.20
Maine X X $3/day NR
Maryland X $115.46 $121.97 $60.59
Massachusetts X $89.21 $89.12/hr $24.40/hr
Michigan X X* $80.98 $51.72
Minnesota X X $75.02 $57.57
Mississippi X X $3/visit $114.87 $ 106.14 $45.50
Missouri X X* $78.32 $78.32 $78.32
Montana X X* $4/visit $76.41 $76.41 $34.12
Nebraska X X X $36.57/hr $22.72/hr
Nevada X $68.88/hr $32.85/hr
New Hampshire X $87.36/hr $23.56/hr
New Jersey X X X* $42.96 $50.36 $39.31
New Mexico X X $133.18 $151.05 $ 111.82
New York X X NR
North Carolina X X $99.86 $101.08 $44.82
North Dakota X $118.00 $35.00 $16.00
Ohio X X* $47.40 $23.57
Oklahoma X* $182.25
Oregon X X X $ 193.63 $53.59
Pennsylvania X X* $93.99
Rhode Island X X X $67.18 $67.18 $22.26
South Carolina X X* $3.30/visit $98.71 $93.69 $43.17
South Dakota X $59.60 $27.80
Tennessee X X* NR
Texas X $3.14 $54.99 $46.09
Utah X NR
Vermont X X $111.70 $50.60/hr
Virginia X X $3/visit $180.02 $73.90
Washington X X $95.45 $63.50 $55.32
West Virginia X X NR
Wisconsin X $85.54 $85.54 $40.31
Wyoming X X X $87.75 $45.50
TOTAL
(51 states):
50 states 11 states 3 states 3 states 25 states 10 states $102.85 average pay rate $89.89 average pay rate $46.80 average pay rate
NOTES: Blank cell indicates state does not elect policy option. NR indicates state did not respond to question. ^Optional therapy services include physical, occupational, and/or speech therapy. *State allows exceptions to hourly service cap. **KS’s $3 copay per skilled nursing visit only applies to fee-for-service enrollees (about 2% of the population) and not to capitated managed care enrollees. SOURCE: KFF Medicaid State Plan Home Health Program Survey, FY 2018.
Appendix Table 3: State Policy Choices About Medicaid Personal Care State Plan Benefits, FY 2018
State Service Site, Besides Home Self-Dir. Provider Type Utilization Controls Provider Reimb. Rate
(per hr.)
Work Other Comm. Setting Agency Indep. Cost Cap Hour Cap Agency Provider
Alaska X X X X X* $24.40
Arkansas X X X X $18.00
California X X X* X $11.25
Colorado X X X ` $60.66 $60.66
DC X X X X $20.08 $13.84
Florida X X X X X X X $15.00 $15.00
Idaho X X X X X $15.76
Kansas NR NR NR NR NR NR NR NR NR
Louisiana X X X* X $11.40
Maine X X X $20.12
Maryland X X X $16.99
Massachusetts X X X X X $15.00
Michigan X X X X X $14.50 $9.25
Minnesota X X X X X* X $17.40
Missouri X X X X $18.12 $15.76
Montana X X X X $19.44
Nebraska X X X X X $9.20 $9.20
Nevada X X X X X $17.00 $17.00
New Hampshire X X X NR NR
New Jersey X X X X X X $15.00 $15.00
New Mexico NR NR NR NR NR NR NR NR NR
New York X X X X NR NR
North Carolina X X $15.60
North Dakota X X X X X $27.96 $20.36
Oklahoma X X X X NR NR
Oregon X X* X $24.61 $14.65
Rhode Island X X X NR NR
South Dakota X X X X $25.24
Texas X X X X X $12.44 $12.44
Utah X X X X $19.08 $11.64
Vermont X X X X X N/A N/A
Washington X X X X X $26.86 $17.91
West Virginia X X X X $16.00
Wisconsin X X $16.72
TOTAL
(34 states):
25 states 23 states 20 states 29 states 16 states 2 states 20 states $19.90 aver. $17.26 aver.
No Personal Care Program (17 states)
Alabama
Arizona
Connecticut
Delaware
Georgia
Hawaii
Illinois
Indiana
Iowa
Kentucky
Mississippi
Ohio
Pennsylvania
South Carolina
Tennessee
Virginia
Wyoming
NOTES: NR = no response. Blank cell = state does not elect policy option. N/A = VT’s program is entirely self-directed, with enrollees setting payment rates, subject to a state-established minimum. *State allows legally responsible relative to be paid provider.
SOURCE: KFF Medicaid State Plan Personal Care Program Survey, FY 2018.
Appendix Table 4: Section 1915 (i) State Plan Services by State and Target Population , FY 2018
Target Population Service Category
Case Management Home-based Services Day Services Nursing/
Therapy Services
Round-the-Clock Services Supported Employment Other Mental/
Behavioral Health Services
Equipment/
Technology/
Modifications
I/DD
(4 states)
2 states
(DE, MS)
3 states
(CA, DE, ID^)
3 states
(CA, ID^, MS)
1 state
(CA)
1 state
(CA)
3 states
(CA, DE, MS)
2 states
(CA, ID^)
2 states
(CA, DE)
Seniors and/or Physical Disabilities
(2 of 3 states responding*)
2 states
(CT, NV)
2 states
(CT, NV)
2 states
(CT, NV)
1 state
(NV)
2 states
(CT, NV)
1 state
(NV)
1 state
(NV)
1 state
(CT)
Mental Illness
(4 states)
3 states
(IN^, IA, TX)
3 states
(IN^, IA, ,TX)
2 states
(IN^, IA)
2 states
(IN^, TX)
1 state
(IA)
2 states
(IA, TX)
3 states
(IN^, OH, TX)
1 state
(TX)
TOTAL
(10 of 11 states responding*):
7 states 8 states 7 states 4 states 4 states 6 states 6 states 4 states
NOTES: Section 1915 (i) states include CA, CT, DE, DC, IA, ID, IN, OH, MS, NV, and TX. *DC did not respond to this survey question. ^ID and IN benefit packages vary by sub-population.
SOURCE: KFF Medicaid HCBS Program Survey, FY 2018.
Appendix Table 5: Section 1915 (c) HCBS Waivers by State and Target Population, FY 2018
State Total Number of Waivers Population Served
I/DD Seniors Seniors &
Adults
with
Physical
Disabilities
Adults with Physical Disabilities Med. Fragile/Tech Dep. Children HIV/AIDS

 

Mental Health TBI/SCI
Alabama 6 X X X
Alaska 4 X X X
Arkansas 4 X X
California 7 X X X X X X
Colorado 11 X X X X X
Connecticut 11 X X X X X X
Delaware 1 X
DC 2 X X
Florida 4 X X X
Georgia 4 X X X
Hawaii 1 X
Idaho 4 X X
Illinois 9 X X X X X X X
Indiana 4 X X X
Iowa 7 X X X X X X
Kansas 7 X X X X X X
Kentucky 6 X X X X
Louisiana 7 X X X
Maine 5 X X X
Maryland 6 X X X X
Massachusetts 10 X X X
Michigan 4 X X X
Minnesota 5 X X X X X
Mississippi 5 X X X X
Missouri 9 X X X X
Montana 4 X X X
Nebraska 5 X X X
Nevada 3 X X X
New Hampshire 4 X X X
New Jersey 1 X
New Mexico 3 X
New York 9 X X X X X
North Carolina 3 X X X
North Dakota 6 X X X X
Ohio 7 X X X
Oklahoma 6 X X X
Oregon 6 X X X
Pennsylvania 10 X X X X
South Carolina 7 X X X X X X
South Dakota 4 X X X
Tennessee 3 X
Texas 6 X X X
Utah 8 X X X X X X
Virginia 5 X X
Washington 8 X X X
West Virginia 3 X X X
Wisconsin 6 X X
Wyoming 5 X X X X
TOTAL
(48 states):
265 waivers 48 states 8 states 37 states 16 states 18 states 5 states 11 states 21 states
No Section 1915 (c) Waivers (3 states)
Arizona
Rhode Island
Vermont
NOTES: I/DD = intellectual and developmental disabilities. TBI = traumatic brain injury. SCI = spinal cord injury. States may offer more than one Section 1915 (c) waiver per target population category. Other states may serve these populations through Section 1115 waivers.
SOURCE: KFF Medicaid HCBS Waiver Survey, FY 2018.
Appendix Table 6: Section 1115 HCBS Waivers by State and Target Population, FY 2018
State Total Number of Waivers Population Served
I/DD Seniors Adults with Physical Disabilities
Med. Fragile/
Tech Dep.
Children
HIV/AIDS
Mental Health
TBI/SCI
TBI/SCI
Arizona 1 X X X
California 1 X X
Delaware 1 X X X X X X
Hawaii 1 X X X X
New Jersey 1 X X
New Mexico 1 X X
New York 1 X X X
Rhode Island 1 X X X X X X X X
Tennessee 1 X X X
Texas 1 X X
Vermont 1 X X X X X
Washington 1 X X X X X
TOTAL
(12 states):
12 states 5 states 12 states 12 states 2 states 3 states 3 states 4 states 4 states
No Stand-Alone Section 1115 HCBS Waivers (39 states)
Alabama
Alaska
Arkansas
Colorado
Connecticut
DC
Florida
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas**
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan*
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
North Carolina**
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
South Carolina
South Dakota
Utah
Virginia
West Virginia
Wisconsin
Wyoming
NOTES: I/DD = intellectual and developmental disabilities. TBI = traumatic brain injury. SCI = spinal cord injury. Other states serve these populations through Section 1915 (c) waivers. *MI has a § 1115 waiver for behavioral health services approved in April 2019. **KS and NC have joint § 1115/1915 (c) waivers.
SOURCE: KFF Medicaid HCBS Waiver Survey, FY 2018.
Appendix Table 7: State Financial Eligibility Criteria for Medicaid HCBS Waivers by Target Population, FY 2018
State I/DD Seniors Seniors & Adults
with Physical Disabilities
Adults with
Physical Disabilities
Med. Fragile/
Tech Dep.Children
HIV/AIDS Mental Health TBI/SCI
Alabama 300% 300% 300% 300%
Alaska 300% 300% 300%
Arizona 300% 300%
Arkansas 300% 300%
California 100% 100% 100% 100% 100% 100%
Colorado 300% 300% 300% 300% 300%
Connecticut 300% 300% 300% 300% 300% 300%
Delaware 250% 250% 250% 250% 250% 250% 250%
DC 300% 300%
Florida 300% 300% 300%
Georgia 300% 300% 300%
Hawaii 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL
Idaho 300% 300%
Illinois 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL
Indiana 300% 300% 300%
Iowa 300% 300% 300% 300% 300% 300%
Kansas 300% 300% 300% 300% 300% 300%
Kentucky 300% 300% 300% 300%
Louisiana 300% 300% 300%
Maine 300% 300% 300%
Maryland 300% 300% 300% 300%
Massachusetts 300% 300% 300%
Michigan 100% FPL 300% 300%
Minnesota 100% FPL 300% 100% FPL 100% FPL 100% FPL
Mississippi 300% 300% 300% 300%
Missouri 300% 170% 300% 300%
Montana 100% 100% 100%
Nebraska 100% 100% FPL 100% FPL
Nevada 300% 300% 300%
New Hampshire 300% 300% 300%
New Jersey 300% 300%
New Mexico 300% 300% 300%
New York 300% FPL 84% FPL 100% FPL 100% FPL 100% FPL
North Carolina 100% FPL 100% 100%
North Dakota 83% FPL 83% FPL 83% FPL 83% FPL
Ohio 300% 300% 300%
Oklahoma 300% 300% 300%
Oregon 300% 300% 300%
Pennsylvania 300% 300% 300% 300%
Rhode Island 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL 100% FPL
South Carolina 100% FPL 300% 300% 300% 300% 300%
South Dakota 300% 300% 300%
Tennessee 300% 300% 300% 300%
Texas 300% 300% 300% 300%
Utah 100% FPL 100% FPL 300% 300% 100% FPL 100% FPL
Vermont 300% 300% 300%
Virginia 300% 300%
Washington 300% 300% 300% 300%
West Virginia 300% 300% 300%
Wisconsin 300% 300%
Wyoming 300% 300% 300% 300%
NOTES: Eligibility Limit as a % of SSI, unless otherwise noted. I/DD = intellectual and developmental disabilities. TBI = traumatic brain injury. SCI = spinal cord injury. Data include § 1915 (c) and § 1115 waivers. States may offer more than one § 1915 (c) waiver per target population category. Blank cell indicates state does not cover that population.
SOURCE: KFF Medicaid HCBS Program Surveys, FY 2018.
Appendix Table 8: State HCBS Waiver Self-Direction and Provider Policy Choices, FY 2018
State Self-Direction Allowed Scope of Self-Direction Direct Care Provider Types
Select/Dismiss Worker Set Worker Schedule Set Worker Pay Allocate Service Budget Agency Indep. Providers Legally Responsible Relative
Alabama X X X X X X X
Alaska X X X
Arizona X X X X X X
Arkansas X* X X X X X
California X X X X X
Colorado X X X X X X X
Connecticut X X X X X X X
Delaware X X X X X X X
DC X X X X X X
Florida X X X X X X X X
Georgia X X X X X X
Hawaii X X X X X X X
Idaho X X X X X X X X
Illinois X X X X X X X X
Indiana X X X X X X
Iowa X X X X X X X X
Kansas X X X X X X
Kentucky X X X X X X X
Louisiana X X X X X X X X
Maine X X X X X X
Maryland X X X X X X X X
Massachusetts X X X X X X X
Michigan X X X X X X X
Minnesota X X X X X X X X
Mississippi X X X X X
Missouri X X X X X X X X
Montana X X X X X X X X
Nebraska X X X X X X X
Nevada X X X X X
New Hampshire X X X X X X X X
New Jersey X X X X X X
New Mexico X X X X X X X X
New York X X X X X X X X
North Carolina X X X X X X X
North Dakota X X X X X X X X
Ohio X X X X X X X X
Oklahoma X X X X X X X X
Oregon X X X X X
Pennsylvania X X X X X X X X
Rhode Island X X X X X X
South Carolina X X X X X
South Dakota X X X X X X X X
Tennessee X X X X X X X X
Texas X X X X X X X
Utah X X X X X X
Vermont X X X X X X X
Virginia X X X X X
Washington X X X X X X X
West Virginia X X X X X X X X
Wisconsin X X X X X X X X
Wyoming X X X X X X X X
TOTAL
(51 states):
50 states 50 states 50 states 39 states 33 states 51 states 49 states 30 states
NOTES: HCBS waivers include § 1915 (c) and § 1115. Some states may apply different self-direction policies to agency-employed vs. independent providers. *AR does not offer self-direction as a waiver service, but waiver enrollees can self-direct attendant services provided under a waiver through § 1915 (j) authority.
SOURCE: KFF Medicaid HCBS Program Survey, FY 2018.
Appendix Table 9: Medicaid HCBS Waiver Waiting List Enrollment, by Target Population and by State, FY 2018
State Waiting List Enrollment by Target Population Total Waiting List Enrollment:
I/DD Seniors Seniors & Adults with Physical Disabilities Adults with Physical Disabilities Med. Fragile/Tech Dep. Children HIV/AIDS

 

Mental Health TBI/SCI
Alabama 2,500 5,080 213 7,793
Alaska 906 0 0 906
Arizona 0 0 0
Arkansas 2,869 234 3,103
California* 0 1,539 3,295 3,600 0 76 8,510
Colorado 2,800 0 0 0 0 2,800
Connecticut 1,865 0 1,600 280 65 74 3,884
Delaware 0 0 0 0 0 0 0
DC* 0 0 0
Florida 21,864 49,798* 0 71,662
Georgia 5,939 820 0 6,759
Hawaii 0 0 0 0 0 0 0
Idaho 0 0 0
Illinois* 19,354 0 0 0 0 0 0 19,354
Indiana 1,495 0 19 1,514
Iowa 1,802 2,860 0 688 1,224 6,574
Kansas 3,673 0 1,557 0 0 0 5,230
Kentucky 9,055 0 0 139 9,194
Louisiana 27,509* 36,743 666 64,918
Maine 1,515* 0 0 1,515
Maryland 10,709 20,500 158 0 31,367
Massachusetts 0 0 0 0
Michigan 0 3,021 0 3,021
Minnesota 31 0 0 0 0 31
Mississippi 1,794 10,224 1,411 81 13,510
Missouri 0 0 100 0 100
Montana 1,810 233 79 2,122
Nebraska 1,627 0 0 1,627
Nevada 378 566 215 1,159
New Hampshire 105 0 0 105
New Jersey NR 0 0
New Mexico 5,030 15,325 20,355
New York 0 NR 0 unknown NR unknown
North Carolina 11,000 3,397 0 14,397
North Dakota 17 0 0 0 17
Ohio* 68,644 0 0 68,644
Oklahoma 7,672 0 0 7,672
Oregon 39 0 143 182
Pennsylvania 16,532 0 0 0 16,532
Rhode Island 0 0 0 0 0 0 0 0 0
South Carolina 11,292 0 0 0 0 0 11,292
South Dakota* 350 0 0 350
Tennessee 7,263 0 7,263
Texas 323,434 35,224 26,550 0 385,208
Utah 2,857 253 0 35 82 108 3,335
Vermont 0 0 0 0
Virginia 13,215 0 13,215
Washington 0 0 0 0 0
West Virginia 1,200 30 6 1,236
Wisconsin 1,516 1,635 3,151
Wyoming 279 0 0 0 279
TOTAL: 589,940 2,358 185,774 11,376 27,213 76 1,498 1,651 819,886
NOTES: I/DD = intellectual and developmental disabilities. TBI = traumatic brain injury. SCI = spinal cord injury. Data include § 1915 (c) and § 1115 HCBS waivers. States may offer more than one § 1915 (c) waiver per target population category. NR indicates state did not respond to question. Blank cell indicates state does not have a waiver serving this population. *CA data include § 1915 (c) waivers only; CA did not report waiver waiting list enrollment for its § 1115 waiver for seniors and adults with physical disabilities. Data are for FY 2018 with the exception of DC, FL (seniors/physical disabilities only), IL, LA (I/DD only), ME (I/DD only), OH, and SD where FY 2017 data are reported.
SOURCE: KFF Medicaid HCBS Waiver Program Survey, FY 2018.
Appendix Table 10:   Medicaid HCBS Waiver Waiting List Enrollment Change, FY 2017 to FY 2018
State FY 2017 FY 2018 Percent Change
Alabama        4,194          7,793 86%
Alaska            629            906 44%
Arizona 0 0 N/A
Arkansas        2,834          3,103 9%
California 7,683**          8,510 11%
Colorado        3,115          2,800 -10%
Connecticut        5,001          3,884 -22%
Delaware 0 0 N/A
DC 0 0* N/A
Florida     71,016 71,662* 1%
Georgia        7,810          6,759 -13%
Hawaii 0 0 N/A
Idaho 0 0 N/A
Illinois     19,354 19,354* N/A
Indiana        1,404          1,514 8%
Iowa        8,004          6,574 -18%
Kansas        4,484          5,230 17%
Kentucky        6,091          9,194 51%
Louisiana     65,989 64,918* -2%
Maine        1,515 1,515* N/A
Maryland     35,143     31,367 -11%
Massachusetts 0 0 N/A
Michigan        3,223          3,021 -6%
Minnesota            237              31 -87%
Mississippi     13,465     13,510 0%
Missouri 0 100 N/A
Montana        2,156          2,122 -2%
Nebraska        3,142          1,627 -48%
Nevada        1,173          1,159 -1%
New Hampshire            105            105 0%
New Jersey 0 0 N/A
New Mexico     17,862     20,355 14%
New York unknown unknown N/A
North Carolina     14,487     14,397 -1%
North Dakota              11              17 55%
Ohio     68,644 68,644* N/A
Oklahoma        7,701          7,672 0%
Oregon            110            182 65%
Pennsylvania        9,504     16,532 74%
Rhode Island 0 0 N/A
South Carolina     10,409     11,292 8%
South Dakota            350 350* N/A
Tennessee        7,428          7,263 -2%
Texas 281,381 385,208 37%
Utah        2,974          3,335 12%
Vermont 0 0 N/A
Virginia     12,266     13,215 8%
Washington 0 0 N/A
West Virginia        2,092          1,236 -41%
Wisconsin        4,198          3,151 -25%
Wyoming            194            279 44%
TOTAL: 707,378 819,886 16%
NOTES: Data include § 1915 (c) and § 1115 HCBS waivers. States with zero waitlist or unknown waitlist in FY 2017, and states that report full FY 2017 data in FY 2018 column are noted with N/A in percent change column. *FY 2017 data is used for DC, FL (seniors/physical disabilities only), IL, LA (I/DD only), ME (I/DD only), OH, and SD. **CA data include § 1915 (c) waivers only.
SOURCE: KFF Medicaid HCBS Waiver Program Survey, FY 2017 and FY 2018.
Appendix Table 11: Average Wait Time by Population for Medicaid HCBS Waivers with Waiting Lists, FY 2018*
Target Population: I/DD Seniors Seniors & Adults with Physical Disabilities Adults with Physical Disabilities Med. Fragile/Tech Dep.Children HIV/AIDS Mental Health TBI/SCI All Populations
Average Number of Months Waiting: 71 28 35 25 29 1 8 27 39
NOTES: I/DD = intellectual and developmental disabilities. TBI = traumatic brain injury. SCI = spinal cord injury. Data include § 1915 (c) and § 1115 waivers. *Of the 41 states reporting one or more waivers with a waiting list in 2018, 30 states reported average wait time for at least one waiver with a waiting list (AL, AK, CA, CO, CT, IN, IA, KS, KY, LA, MD, MI, MN, MS, MO, MT, NE, NM, NC, ND, NV, OK, OR, PA, SC, SD, TN, TX, WV, and WY), and 11 states (AR, FL, GA, IL, ME, NH, NY, OH, UT, VA, and WI) did not report average wait time for any waivers with waiting lists.
SOURCE: KFF Medicaid HCBS Waiver Program Survey, FY 2018.
Appendix Table 12: State HCBS Waiver Utilization Control, Quality Measure and Ombuds Policy Choices, FY 2018
State Utilization Controls Quality Measures Ombuds Programs Operated By:
Cost Cap Hour Cap Geo. Limit Quality of Life Community Integration LTSS Rebalancing State Gov’t Community-based Agency Another Entity
Alabama X X X X
Alaska X X X
Arizona X X X
Arkansas X X X
California X* X* X X X X
Colorado X X X X X
Connecticut X X X X X
Delaware X* X* X X X X
DC X X X
Florida X* X* X X X X
Georgia X* X X X
Hawaii X X X X X
Idaho X X X X
Illinois X* X X X
Indiana X X X X X X
Iowa X* X X X X
Kansas X X X X
Kentucky X* X* X X X
Louisiana X* X X X X X
Maine X X X X NR
Maryland X* X* X X X X
Massachusetts X* X* X X X X
Michigan X X X
Minnesota X* X X X X
Mississippi X X X
Missouri X* X*
Montana X* X* X X
Nebraska X X X
Nevada X X X X
New Hampshire X* X X X X
New Jersey X X NR
New Mexico X* X X X
New York X* X* X X X
North Carolina X X* X
North Dakota X X* X
Ohio X* X* X X X X
Oklahoma X* X X
Oregon X X X
Pennsylvania X X X X
Rhode Island X X
South Carolina X* X X X
South Dakota X* X* X X X
Tennessee X* X* X X X X X
Texas X* X* X X X X
Utah X X X
Vermont X* X X X
Virginia X X X X
Washington X* X X X X
West Virginia X X X X
Wisconsin X X X X X
Wyoming X* X X X
TOTAL
(51 states):
34 states 20 states 4 states 46 states 44 states 25 states 36 states 4 states 5 states
NOTE: HCBS waivers include § 1915 (c) and § 1115. Blank cell indicates state does not adopt policy. NR indicates state did not respond to question. * indicates state allows exception to cost/hour cap.
SOURCE: KFF Medicaid HCBS Program Survey, FY 2018.
Appendix Table 13: State Capitated MLTSS Policy Choices, FY 2018
State Financial Incentives for HCBS Instead of Institutional Services^ Value-Based Payment for HCBS Independent Enrollment Options Counseling Disenrollment if LTSS Provider Leaves Plan Network Stakeholder Advisory Committee
Use Now Future Plan to Use/Expand State-Level Health Plan Level
Arizona X X X X
Arkansas* NR X NR X X X
California X X X X X
Delaware X X X X X X
Florida X X X X X
Hawaii X X X X
Idaho NR X X X X
Illinois NR NR X X X
Iowa X X X X X X
Kansas X NR X X X X
Louisiana NR X X X
Massachusetts NR NR
Michigan X X X X
Minnesota X NR X X X
New Jersey NR X X X X
New Mexico X X X X X X
New York X X X X X X
North Carolina NR NR NR X
Ohio X NR X X X X
Pennsylvania X X X X X X
Rhode Island NR NR X X X
South Carolina X NR X X X X
Tennessee X X X X X X X
Texas NR X X X X X
Virginia X X X X
Wisconsin X X X X X X
TOTAL
(26 states):
14 states 7 states 10 states 19 states 20 states 23 states 22 states
No MLTSS Program in FY 2018 (25 states):
Alabama
Alaska
Colorado
Connecticut
DC
Georgia
Indiana
Kentucky
Maine
Maryland
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
North Dakota
Oklahoma
Oregon
South Dakota
Utah
Vermont**
Washington
West Virginia
Wyoming
NOTES: NR indicates state did not respond to question. Blank cell indicates state does not adopt policy. *The capitated portion of AR’s program began in FY 2019. **VT has a non-risk based MLTSS program as of Sept. 2017. ^FL and SC offer transition bonus payments, CA did not specify incentive type, all other states offer blended rates.
SOURCE: KFF Medicaid HCBS Program Survey, FY 2018.
Appendix Table 14: State Policy Choices About Electronic Visit Verification (EVV), FY 2018
State EVV for Personal Care Services^ EVV for Home Health State Plan Services
In place in FY 2018^ In place by January 2020^ Plans to request good faith exemption^ EVV Model Vendor Type In place in FY 2018 In place by year EVV Model Vendor Type
Alabama X^ X* State mandated external 2023 Undecided
Alaska X* Open Unknown Undecided
Arizona X Open 2020 Open vendor
Arkansas X^ Other NR Other
California X Undecided NR NR
Colorado X X* Other 2020 Other
Connecticut X X X* State mandated external 2023 State mandated external
Delaware X Open 2020 Open vendor
DC X* NR NR NR
Florida X X State mandated external X State mandated external
Georgia X Open 2023 Open
Hawaii X Open 2020 Open
Idaho X Other Unknown Other
Illinois NR NR Undecided 2023 Undecided
Indiana X X Open 2023 Open
Iowa X* Undecided 2023 Undecided
Kansas X State mandated external Unknown State mandated external
Kentucky X X* Open 2020 State mandated external
Louisiana X^ Other 2023 State mandated in-house
Maine X^ X* Provider choice 2019 Provider choice
Maryland X X State mandated external 2023 Other
Massachusetts X Other 2023 Other
Michigan X Open 2023 Open
Minnesota X Open Unknown Open
Mississippi X X Other Unknown NR
Missouri X X X* Provider choice 2020 Provider choice
Montana X Other 2023 Other
Nebraska X X Open 2021 Open
Nevada X^ Other 2023 Open
New Hampshire X X Provider choice NR Provider choice
New Jersey X State mandated external 2022 State mandated external
New Mexico X^ X X Other 2023 Other
New York X X Undecided NR NR
North Carolina X Open 2023 Open
North Dakota X Open 2021 Provider choice
Ohio X X X Open** X Open
Oklahoma X X Other X Open
Oregon X Open Unknown NR
Pennsylvania X Open 2023 Open vendor
Rhode Island X^ X* Provider choice X Provider choice
South Carolina X X Other 2022 Open
South Dakota X^ Open 2019 Open
Tennessee X X Other 2023 Other
Texas X X X* Other 2023 Other
Utah Provider choice Unknown Provider choice
Vermont X^ X Open 2023 Open
Virginia X Open 2023 Provider choice
Washington X^ X Provider choice Unknown NR
West Virginia X X^ X* Other Unknown Other
Wisconsin X* Other 2023 Other
Wyoming X State mandated external 2023 State mandated external
TOTAL
(51 states):
16 states 27 states 35 states   4 states    
NOTES: ^Personal care includes services delivered under the state plan option and HCBS waivers. AL, LA, NM, and RI have implemented EVV for all personal care services across all authorities, and AR, ME, NV, SD, VT, WA, and WV plan to do so by 2020; other states’ implementation dates and exemption plans apply to some but not all personal care authorities. *As of Feb. 2020, 13 states have received approval for a good faith exemption. **OH reported open vendor except that managed care plans must use the state vendor.
SOURCE: KFF Medicaid HCBS Program Surveys, FY 2018.
Appendix Table 15: State Policy Choices About HCBS Settings Rule, FY 2018
State State Rule/Policy Changed or Must Change Settings Must Be Modified Settings Cannot Be Modified Settings Presumed Institutional Because Effectively Isolate Beneficiaries Plans To Submit Or Has Submitted Information to Overcome Institutional Presumption
Alabama X X (1)
Alaska X X (613) X (12)
Arizona X X (4) X (5)
Arkansas X NR NR NR NR
California X
Colorado X X (TBD) X (TBD) X (TBD)
Connecticut X X (43) X X
Delaware X X (460) X (1) X (1)
DC X X
Florida X X (TBD) X (1) X (TBD) X (TBD)
Georgia X X
Hawaii X X (1,760) X (11)
Idaho X X (47) X (3) X X
Illinois X X X
Indiana X X (1,010)
Iowa X X (218) X (2) X (52) X (45)
Kansas X
Kentucky X X (404) X X (95) X (95)
Louisiana X X (90)
Maine
Maryland X (26) X (2) X (17) X (17)
Massachusetts NR
Michigan X X (1,479) X (1,138)
Minnesota X X (51) X (135) X (265)
Mississippi X
Missouri X X (241) X (15) X (127) X
Montana X X X
Nebraska X X (255) X (2) X
Nevada X X X X (3)
New Hampshire X X (1,984) X X (64) X (54)
New Jersey X
New Mexico X
New York X X (311) X X
North Carolina X X X (20)
North Dakota X X (108) X (6) X (6)
Ohio X X (397) X (4) X (69)
Oklahoma X X (21) X (4)
Oregon X X (1,678) X X (7) X (16)
Pennsylvania X X X
Rhode Island X X (14) X
South Carolina X X (1,321) X (3) X (2)
South Dakota X X (70) X (14) X (26)
Tennessee X X X X X
Texas
Utah X X X X
Vermont X
Virginia X
Washington X X (8) X (1) X (1)
West Virginia X X (100) X (100)
Wisconsin X X X X (TBD)
Wyoming X X (2) X (2)
TOTAL
(51 states):
47 states 39 states 20 states 26 states 22 states
NOTES: NR indicates state did not respond to question. Numbers in parentheses indicate number of settings. TBD indicates number of settings to be determined.
SOURCE: KFF Medicaid HCBS Program Survey, FY 2018.
Appendix Table 16: State Policy Choices About Direct Care Worker Minimum Wage and Overtime, FY 2018
State Restrict Worker Hours or Other Policy Change (new in FY 2018 or continued from prior year) Limit Worker Hours to 40 hours/week (new in FY 2018 or continued from prior year) Budget State Funds for Worker Overtime Pay in 2019 Budget State Funds for Worker Travel Time Pay in 2019
Alabama X X
Alaska
Arizona X X
Arkansas
California X X X
Colorado
Connecticut X X X
Delaware X X
DC
Florida
Georgia X X
Hawaii
Idaho
Illinois X X
Indiana
Iowa
Kansas X X
Kentucky X X
Louisiana X
Maine
Maryland X X
Massachusetts X X
Michigan
Minnesota
Mississippi X X
Missouri
Montana
Nebraska X X
Nevada X X
New Hampshire X
New Jersey X
New Mexico X X
New York
North Carolina
North Dakota X X
Ohio X X X
Oklahoma X X
Oregon X X X X
Pennsylvania X
Rhode Island
South Carolina X X
South Dakota
Tennessee X
Texas
Utah X
Vermont X X X
Virginia X X
Washington X X X X
West Virginia
Wisconsin X X X
Wyoming X X
TOTAL
(51 states):
21 states 14 states 17 states 13 states
SOURCE: KFF Medicaid HCBS Program Surveys, FY 2016-2018.
Issue Brief