Terence Ng, MA, Dept of Social and Behavioral Sciences, University of California San Francisco, 3333 California Ave, Suite 455, San Francisco, CA 94118, (415) 502 6330, tng@itsa.ucsf.edu, Martin Kitchener, PhD, MBA, Department of Social & Behavioral Sciences, University of California San Francisco, 3333 California St, Suite 455, San Francisco, CA 94143-0612, and Charlene Harrington, PhD, Disability Statistics Center, Institute for Health & Aging, University of California, San Francisco, 3333 California Street, Room 340, San Francisco, CA 94118.

During the 1990s, in response to growing consumer demand and legal pressures for Medicaid alternatives to institutional long-term care (LTC), states steadily expanded 1915(c) Medicaid home and community based services (HCBS) waiver programs to targeted populations including HIV/AIDS and the elderly. These programs provide services such as personal care and home modifications that enable participants to continue living at home or in the community. It is known that while waiver development has been uneven across the states, access has generally improved for populations including the elderly and disabled. However, less is known about the development of waivers targeted towards people living with HIV/AIDS, even though they are recognized as an increasingly popular option for people living with mid to advanced stages of HIV/AIDS compared to institutional care. This paper uses a unique longitudinal dataset to present the latest trend data (through 2002) on participants and expenditures on Medicaid 1915(c) HCBS waivers for HIV/AIDS. The findings indicate that against a background of state fiscal crises and reduced growth rates on waivers in general, growth rates on HIV/AIDS waivers have slowed at a faster rate. We then draw from a survey of all states to examine the role of changing financial eligibility, and need policies as well as expanding waiting lists to slow growth in HCBS waivers targeted towards people living with HIV/AIDS.

Learning Objectives: From this session participants will be able to

(
• identify trends in the development (participants and expenditures) of Medicaid 1915(c) HCBS waivers targeted towards people living with HIV/AIDS, (
• compare these with participation and expenditure trends for HCBS waivers targeted towards other populations (e.g., the elderly, (
• understand state responses to fiscal crises in terms of Medicaid policy changes concerning HIV/AIDS waivers, and (
• consider the potential impact on access to Medicaid LTC services for people living with HIV/AIDS.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.