RISP Data Bytes

RISP Data Byte May 2026 Access to Medicaid Waiver Services Varies by State: Data from fiscal year 2021

Plain Language Summary | In 1982, Medicaid began the Home and Community-Based Services (HCBS) Waiver program to support people in their communities. Today, 288 people with intellectual and developmental disabilities (IDD) for every 100,000 people in the U.S. get Medicaid Waiver-funded services. Some states serve many more people with IDD than other states through the HCBS Waiver program.

Background

In 1982, Medicaid began the Home and Community-Based Services (HCBS) Waiver program. Before then, the only way for people with IDD to get services was to move to an institution. Institutions keep people with IDD from participating in their communities. HCBS Waivers help people stay in their communities.

Key Finding

In 2021, an average of 288 people with IDD for every 100,000 people in the U.S. got Medicaid HCBS Waiver-funded services. State HCBS Waiver programs served between 83 people with IDD and 804 people with IDD per 100,000. Many factors explain differences between states. For example, the number is affected by whether the state IDD agency serves children with IDD or not.

Map of the United States showing the number of people per 100,000 who received Medicaid HCBS Waiver services by state. The states that provided HCBS to 86 to 200 people per 100,000 were Alabama, Arkansas, Delaware, Florida, Georgia, Illinois, Mississippi, Nevada, Oklahoma, Tennessee, Texas, Utah, and Virginia. The states that provided HCBS to 201 to 400 people per 100,000 were Alaska, California, Colorado, Connecticut, the District of Columbia, Hawaii, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Missouri, Montana, Nebraska, New Jersey, New Mexico, Ohio, Pennsylvania, Rhode Island, South Carolina, Washington, and West Virginia. The states that provided HCBS to 401 to 804 people per 100,000 were Arizona, Idaho, Indiana, Iowa, Michigan, Minnesota, New Hampshire, New York, North Dakota, Oregon, Vermont, Wisconsin, and Wyoming. North Carolina and South Dakota did not provide data.

Recommendations

Some people want to decrease HCBS Waiver spending. The HCBS Waiver program needs more money, not less. Offering HCBS Waivers to people can save money by keeping people with IDD out of expensive institutions. People with IDD should be supported to live meaningful, dignified lives in their communities.

Data Source

Larson, S.A., Neidorf, J., Pettingell, S., Nye-Lengerman, K., & Vegas, L. (2025). Long-term supports and services for persons with intellectual or developmental disabilities: Status and trends through 2021. University of Minnesota, Institute on Community Integration, Research and Training Center on Community Living. https://doi.org/10.13140/RG.2.2.10719.11682

Authors

Sheryl A. Larson, Jon Neidorf, and Sarah A. Hall.

The RISP project gets funds from the Administration on Community Living, U.S. Department of Health and Human Services, Cooperative Agreement #90DNPA0006 with supplemental funding from the National Institutes on Disability, Independent Living and Rehabilitation Research Grant #90RTCP0011.

Abbreviations used: IDD stands for Intellectual or Developmental Disabilities; HCBS stands for Home and Community Based Services

Updated 5/27/2026