In 1981, Congress created the home and community-based (HCBS) waiver program. These waivers allow states, if they choose, to extend home- and community-based Medicaid services to individuals who would otherwise qualify for care in a nursing home or institution. Essentially, these waivers allow truly needy individuals on Medicaid to receive additional care they need without being institutionalized.
The waiver programs are comprised of individuals with severe intellectual disabilities, traumatic brain injuries, spinal cord injuries, and mental illnesses, among other debilitating conditions.
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Medicaid spending and enrollment has skyrocketed in recent years, crowding out resources for all other state priorities. The number of people dependent on Medicaid has more than doubled since 2000, with nearly 75 million individuals currently enrolled in the program. Nowhere is this growth more evident than among able-bodied adults. Nearly 28 million able-bodied adults are now dependent on the program, up from fewer than 7 million in 2000.
This enrollment explosion is fueling a massive spending surge. Total Medicaid spending has nearly tripled since 2000 and spending on able-bodied adults has increased by a jaw-dropping 700 percent.
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