This project explores impacts of implementation of Medicaid Home and Community Based (HCBS) Waiver initiatives in support of children and families who experience autism. In a two-pronged approach, the project studies state policy makers and factors contributing to or impeding implementation of HCBS autism waivers at the state level, and studies families and youth in a state with an autism waiver in place -- Maryland -- to learn more about service needs, impacts of the waiver on children/youth and families, and service configurations that may make the most difference to children with autism and their families at younger ages as compared to transition ages. In Study One, Phase 1 involves in-depth qualitative interviews with policy makers in four states concerning perspectives about facilitators and barriers to implementing HCBS waivers in general and autism waivers in particular. These results are used to develop a national survey to be distributed in Phase 2 to all 50 states. Study Two involves in-depth qualitative interviews with 48 Waiver and Registry families to probe their perspectives about their child and family needs, impacts of the child's disability, concerns about approaching transitions, and impacts of the services they are receiving. The results of this study inform Phase 2 of Study Two (as well as any additional issues identified in the national survey of states from Study One), which is a statewide survey distributed to families receiving Waiver services and on the Registry list.Study tests the hypothesis that child/family demographic characteristics (ethnicity, race, income, education) will not significantly change the outcomes for families and children/youth who are on the waiver program.