In August 1981, Congress created an alternative program of Medicaid Home and Community-Based Services (HCBS) Waiver for persons who might otherwise be at risk of placement in a Medicaid-funded institution. In Fiscal Year (FY) 2001, for the first time since its creation 20 years earlier, Medicaid HCBS Waiver programs for persons with intellectual and developmental disabilities had federal and state expenditures that exceeded those for Medicaid Intermediate Care Facilities for Persons with Mental Retardation (ICFs/MR). As summarized in Tables 1 and 2, in FY 2001, states reported a total of 10.9 billion federal and state dollars spent for services in the HCBS program to serve an end of year (June 30, 2001) total of 327,713 people. In FY 2001, a reported total of 10.3 billion dollars in federal and state expenditures was spent for ICF/MR services for a reported 113,907 ICF/MR residents. In...

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