Evaluating a Medicaid home and community-based physical disability waiver.

State Medicaid waivers have fostered innovative health delivery systems for persons with special needs. Yet their overall cost effectiveness remains poorly understood. Changes were recently analyzed in Medicaid health services and costs for persons newly enrolled in the Kansas Physical Disability (PD) Waiver and found that ambulatory services increased, consistent with meeting enrollees' unmet medical needs and their access to enriched services. Home health, transportation, and personal care services also rose. Though not significant, hospital inpatient, outpatient, and long-term care services declined. This movement towards community-based service use in the short term reflects improved self-directed care and possible long-term cost savings.