State-level Medicaid 1915(c) home and community-based services waiver support for caregivers

Background: Informal caregivers encounter emotional distress, worsening per-sonal health, and financial strain. The Medicaid 1915(c) Home and Community-Based Services (HCBS) waiver programs provide an array of services including support for caregivers.Purpose: This policy analysis examined Medicaid waiver services offered to per-sons 65 and older among the 50 states and District of Columbia (DC).Methods: Data were obtained from Medicaid waiver applications for adults age 65 and older available at Medicaid.gov. Data elements included number of waiver pro-grams and services for supporting caregivers. Descriptive statistics were applied.Findings: Forty-three states including DC (84%) offered a Medicaid waiver for older adults; seven states (14%) offer two waiver programs; eight states (16%) had no Medicaid waiver. Payment to a relative or legal guardian caregiver was the most common service offered in 39 (76%) states. Other services included in-home respite care and adult day health care (35 states; 67%), out-of-home respite care (32 states; 63%), skilled nursing (28 states; 55%), paid spousal caregivers (18 states; 35%), care -giver training (15 states; 29%), and adult day care for socialization (7 states, 14%). Discussion: This study identifies wide variability in caregiver support across state -based Medicaid waivers. Future research should evaluate effectiveness of the waiver programs in supporting caregivers and inform evidence-based policy advocacy for supporting caregivers.