Appropriations subcommittee hears Medicaid officials explain 1915(c) waiver wait‑list churn, recent slot additions and $1.8B in FY25 waiver spending

State Medicaid officials on Thursday briefed the Committee on Appropriations & Revenue subcommittee on the Commonwealth’s 1915(c) home‑ and community‑based services waiver programs, explaining why large wait lists persist even as some slots appear available.

Leslie Hoffman, deputy commissioner for the Department for Medicaid Services, told the panel the state manages multiple 1915(c) waivers — including the Acquired Brain Injury waivers, the HCB waiver, the Michelle P waiver, Supports for Community Living (SCL), a small Model waiver, and a new child waiver — each with distinct eligibility and waiver‑year timing. Hoffman said an unduplicated count of people on waiver wait lists is 18,948 and described the difference between funded, filled, allocated and reserved slots.

Hoffman and Carmen Hancock, division director for long‑term services and supports, said slot availability is a continuous 'churn' driven by reserved slots required by federal demonstrations (money‑follows‑the‑person), emergency reserves approved by CMS, newly allocated slots from legislation, and vacated slots from deaths, moves out of state or admissions to institutions. Hancock gave an example that the HCB waiver averages about 125 vacated slots per month that cannot all be immediately reissued because many slots remain tied to the waiver year.

Hancock said fiscal‑year‑25 waiver service payments (the waiver portion only) totaled about $1,800,000,000. She also presented county distributions of active waiver participants (top counties included Jefferson and Fayette) and traced member growth since 2020 using the verified data the agency submits to CMS.

Officials told lawmakers that House Bill 500 slots were added on July 1 under prior legislation, and House Bill 6 (the 2024 budget bill) provided an additional 500 HCB slots beginning July 1, 2025, producing a visible jump in reserved slot counts in July–September on the agency’s charts. They said those slots were added with CMS approval and are entering the allocation 'churn.'

On timing, officials explained that many waivers run on different waiver years (most on May; HCB begins Aug. 1), and federal CMS rules generally prevent reissuing a slot to another person once that person has received any waiver service in the waiver year. That constraint, they said, is a central driver of why vacated slots are reconciled only at waiver‑year rollover rather than immediately.

Committee members asked for methodological clarity about wait‑time calculations, including whether averages represent entire historical periods or recent windows; Hancock said the agency would dig into the specific calculation windows and return with clarified analyses. Officials also clarified reallocation rules: typically a person who receives no services forfeits a slot after a 60‑day nonengagement period with a potential 60‑day extension (i.e., 60–120 days) in some waivers.

The administration told the subcommittee it will return in early October with a House Bill 2‑mandated report that will include targeted recommendations, proposed education and screening steps for families, and planned next actions. The agency said a major piece of the work will be better public education on what waiver enrollment provides and who is likely to benefit from waiver services.

Commissioner Lisa Lee emphasized that waiver services — homemaking, personal care (bathing and toileting) and other nonmedical supports — fill gaps private insurance typically does not cover and allow people to remain at home.

The subcommittee took no formal votes. Members directed the agency to provide updated calculations and additional data in the fall report.