Supported employment and the medicaid home and community-based waiver authority: Current status and unresolved issues

The article reviews the current status of the Medicaid HCB (home and community-based) waiver and the use of its supported employment provisions, outlining major factors involved in its low utilization, including: (a) lack of prior institutionalization in the histories of two-thirds of waiver participants, (b) the tendency of states to limit eligibility to individuals with the most extensive support and service needs, (c) delays in implementing the supported employment coverage option, (d) the fact that eligibility is limited to individuals who would otherwise require institutional care. (e) the fact that supported employment is defined as a sub-element of habilitation services and applicable only to waiver participants with developmental disabilities, and (f) the general barriers to expanding supported employment services, particularly to individuals with severe disabilities. Unresolved federal policy issues are discussed and information on obtaining a more complete report are also included.