State Approaches to Funding Home and Community-Based Mental Health Care for Non-Medicaid Youth: Alternatives to Medicaid Waivers

  • Genevieve GraafEmail author
  • Lonnie Snowden
Original Article


Home and Community-Based Services (HCBS) Medicaid waivers for children increase the availability of public funding for HCBS by waiving or expanding the means tests for parents’ income, basing child eligibility for Medicaid coverage primarily on clinical need. But many states provide mechanisms apart from HCBS waivers to increase coverage for youth with significant mental health needs. Through interviews with public mental health officials from 37 states, this study identifies and explains non-waiver funding strategies for HCBS services for otherwise ineligible youth. Results demonstrate that states expand Medicaid-eligibility through CHIP or use state general revenue funds to pay for medically necessary HCBS for non-Medicaid youth.


Home and community-based services Children’s mental health Mental health financing Public mental health Systems of care 



This study was not funded.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Social WorkUniversity of Texas, ArlingtonArlingtonUSA
  2. 2.School of Public HealthUniversity of California, BerkeleyBerkeleyUSA

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