Assistive technology in the landscape of Medicaid HCBS waivers: national trends and gaps for people with physical disabilities

BACKGROUND: Medicaid Home and Community Based Service (HCBS) waivers provide services for individuals with disabilities in the United States (U.S.) who are at risk of institutionalization. Assistive technology (AT) is a covered service category that includes devices, systems, and supports such as adapted or mainstream technologies to enhance independence and participation. However, variation in state HCBS waiver policies may facilitate or hinder access to AT devices and related services, resulting in differences in availability, coverage, and implementation. OBJECTIVE: This study examined the availability, scope, and disparities in AT services across state Medicaid HCBS waivers serving persons with physical disabilities (PwPD) in the U.S. Methods We conducted a content analysis of standalone AT services and AT-related services within Medicaid HCBS waivers for PwPD. AT-related services include home modifications, personal emergency response systems (PERS), remote supports, specialized medical equipment and supplies (SMES), and state-created AT services. RESULTS: The analysis included 57 waivers (22% of all HCBS waivers) from 38 states serving PwPD and included an AT service, AT-related service, or both. Seventeen waivers (30%) across 13 states included both AT and AT-related services, while 40 waivers (70%) across 30 states offered only AT-related services. Collectively, these waivers provided 20 AT services, 55 home modification services, 46 PERS services, three remote support services, 36 SMES services, and 11 state-created AT services. CONCLUSION: Substantial variability exists in AT coverage within HCBS waivers for PwPD. Many states lack clear AT definitions, and some exclude mainstream technology acquisition, potentially creating service gaps that hinder long-term AT use and increase institutionalization risk.