About this srcd poster session

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Panel information
Panel 21. Social Policy

Abstract

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The home and community-based services (HCBS) child waiver program aims to expand access to and ease the financial burden of specialized health care services and supports for families with children who have special health care needs in the United States (Williams & Musumeci, 2021). HCBS programs encourage family-centered care models that have been shown to boost family emotional well-being, reduce guardian stress, and improve children’s health and behavior (Hays et al., 2006; Kuo et al., 2012; Law et al., 2003). In Colorado, families eligible for HCBS programs are offered the following waivers: Children’s Home and Community Based Services Waiver (CHCBS), Children with Life-Limited Illness Waiver (CLLI), Children’s Extensive Support Waiver (CES), and Children’s Habilitation Residential Program Waiver (CHRP). Colorado recently expanded their evaluation of members’ experiences with child waiver programs, with the goal of identifying ways to improve services and supports and to measure impact over time. The purpose of the current study was to examine (a) member satisfaction across the waiver programs, (b) challenges and successes with accessing and maintaining services for children, and (c) variations in experiences with services by waiver program, geographic location, and child age group.

A statewide survey was distributed to 5,259 families with children (ages 0-18) enrolled in one of the four Colorado HCBS waiver programs (i.e., CHCBS, CLLI, CES, CHRP). The response rate was robust, exceeding the previous year’s response rate to a similar survey (i.e., Child Family Survey). Due to Safe Harbor laws in Colorado, further information on the sample size cannot be disclosed. The child waiver survey was developed by conducting a literature review, completing four focus groups with family members whose children were enrolled in waiver programs, refining the survey with state administrators, and piloting the survey with the target population. The final survey included the following topics: access and understanding of waiver programs, case management and service planning, child services and supports, family needs and supports, transition needs for young adults, and health insurance and other benefits. Descriptive statistics and chi-square tests were calculated to examine patterns in families’ experiences with the waiver programs.

High satisfaction in services and additional successes were apparent across the four waiver programs. Families were generally satisfied with the services they received, very few respondents reported a lapse in waiver coverage, and the waivers appeared to successfully reduce the financial burden of health care (Table 1). Challenges were apparent as some respondents reported that there were barriers to enrolling in or accessing the waiver services, case manager turnover could cause disruptions, and families with older adolescents reported feeling unprepared for their children’s upcoming transition as they aged out of the waiver programs (Table 1). Chi-square tests comparing experiences by waiver program revealed that CES families experienced more challenges than CHCBS families, rural residents experienced more challenges than urban residents, and families with younger children experienced fewer challenges and were more satisfied with services compared to families with older children (Table 2). Implications for policymakers and practitioners to improve HCBS waiver programs will be discussed.

Author information

Author	Role
Anna Kimura, Vital Research	Presenting author
Cathy Coddington, Vital Research	Non-presenting author
Rachel Newton, Office of Community Living, Colorado Department of Health Care Policy and Financing	Non-presenting author
Mitzi Ochoa, Vital Research	Non-presenting author
Sarah Hoerle, Office of Community Living, Colorado Department of Health Care Policy and Financing	Non-presenting author

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