Medicaid 2176 home and community-based care waivers: the first ten years.

Budget reconciliation legislation in 1981 created a waiver program whereby states could provide home and community-based care under Medicaid for certain populations. States spent nearly $1.7 billion on services delivered under these waivers, known as 2176 waivers, in 1991, compared with $3.8 million in 1982, when only six states were participating in the program. Although these programs have not been rigorously evaluated for effectiveness, they continue to be a popular approach to delivering care outside of institutions for various groups. Across all states, states spent 13.4 percent of their Medicaid long-term care dollars on care outside of institutions (which includes the 2176 waiver program).