JOURNAL OF POLICY AND PRACTICE OF INTELLECTUAL DISABILITIES: Self‐direction in Medicaid home‐ and community‐based services
This study’s aim was to examine how states across the United States implemented self-direction in their Medicaid home and community‐based services (HCBS) 1915(c) waiver programs for people with intellectual and developmental disabilities (IDD) in fiscal year (FY) 2021. Eighty percent of states offered self-direction in their HCBS programs. Across the United States, the goal was to have 13 percent of people with IDD receiving HCBS self-direct. In FY2021, 29 percent of services could be self-directed and 36 percent of funding was projected for services eligible for self-direction. There were vast differences in how self-direction was implemented across states. For example, among the states that allowed self-direction, goals for self-direction by state ranged from 0.9 percent to 47.5 percent of people with IDD receiving HCBS. Projected spending for services eligible for self-direction varied by state from 0.1 percent to 100 percent.
