Variations in HCBS Spending, Use, and Hospitalizations among Medicaid 1915(c) Waiver Enrollees

Medicaid home‐ and community‐based services (HCBS) waiver programs serve a population at high risk for hospitalization. We examined whether enrollees in HCBS programs, in 21 states representing all regions of the United States, with higher intensity of services, measured by HCBS spending per enrollee, have lower rates of hospitalization and potentially avoidable hospitalization (PAH). We found no statistically significant association with hospitalization. This suggests that HCBS programs that provide higher intensity services are not focusing effort on reducing hospitalization. We also found that HCBS waiver enrollees in programs with greater generosity in eligibility, measured by a higher proportion of HCBS receipt among long‐term services and supports (LTSS) users, had statistically significantly lower rates of hospitalization and PAH. This suggests that more generous programs serve waiver enrollees who are at lower risk of hospitalization, which may be relevant to policymakers in establishing the eligibility criteria.