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The Use of Medicaid Waivers and their Impact on Services

Spearman, Russell C. MEd*; Stamm, Beth Hudnall PhD; Rosen, Bruce H. MBA, CSW; Kayala, Dianne E. MS§; Zillinger, Margaret RN; Breese, Patricia MA, CCM; Wargo, Lorraine M. RN#

The Journal of Head Trauma Rehabilitation: February 2001 - Volume 16 - Issue 1 - p 47–60
Public Policy Issues

This article examines Medicaid waivers to provide services to adults with traumatic brain injury (TBI) who are Medicaid eligible in the community and who would otherwise be placed in nursing homes or who meet nursing home levels of care. Medicaid waivers for individuals with TBI were addressed through a review of six TBI Waivers (Colorado, Idaho, Kansas, New York, Rhode Island, and Vermont). A summary of the services covered by the waivers is provided. Review of the data suggests two processes, obtaining a waiver and implementing a waiver. Four characteristics were linked to obtaining waivers (a) social-medical-political climate, (b) similarity to other waivers, (c) ability to strengthen access and reduce barriers, and (d) expenditure of resources. Similarly, four theoretical characteristics were posited to be associated with managing waivers: (a) cost effectiveness, (b) developmental process of waiver implementation, (c) ability to improve access and reduce barriers, and (d) expenditure of resources to manage the waiver.

Traumatic Brain Injury Project Manager (Spearman)

Research Associate Professor and Assistant Director (Stamm)

Director (Rosen)

Chief (Kayala)

Traumatic Brain Injury Program Coordinator (Zillinger) (Breese) (Wargo)

*Institute of Rural Health

Pocatello, Idaho

Traumatic Brain Injury Home and Community-Based Medicaid Waiver Services, New York State Department of Health, Delmar, New York

§Family Health Systems, Rhode Island Department of Human Services, Cranston, Rhode Island

Health Care Policy Department of Social and Rehabilitation Services, Topeka, Kansas

Colorado Department of Health Care Policy and Financing, Denver, Colorado

#Vermont Department of Aging and Disabilities, Division of Vocational Rehabilitation Waterbury, Vermont.

Correspondence may be addressed to Russell C. Spearman, Institute of Rural Health, Idaho State University, Pocatello, ID 83209-0001. E-mail:

© 2001 Lippincott Williams & Wilkins, Inc.