| Sumario: | Part of a special section on ambulatory and community-based health-care services. The writers discuss trends and issues associated with the Medicaid 1915(c) waiver program. Over the past 15 years, these home- and community-based waivers have contributed to states' efforts to change their long-term care (LTC) systems from institutional to community-based systems. By 1997, expenditures had increased to over $8.1 billion, as every state had implemented a waiver program for at least some subgroups of individuals with disabilities. Emerging and extant policy issues associated with the waiver program include state decisions related to the provision of community-based LTC, variation in availability by disability group, concerns with access, and evidence of effectiveness.
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