Expenditures on services for persons with acquired immunodeficiency syndrome under a Medicaid home and community-based waiver program. Are selection effects important?
OBJECTIVE
In 1990, the state of Florida implemented an acquired immunodeficiency syndrome (AIDS)-specific Medicaid waiver program to provide home and community-based services to AIDS patients as an alternative to institutional care. The program is available to Medicaid beneficiaries with AIDS who are at risk of institutionalization. This study examines whether the waiver option was effective in reducing Medicaid expenditures per beneficiary during its first 2 years of operation.


METHODS
The authors used Medicaid claims data and county information on the availability of health services to model the selection of the waiver option by AIDS patients and then to estimate the effect of the waiver on expenditures controlling for nonrandom program selection.


RESULTS
The results indicate that the selection model is highly significant, but that the influence of nonrandom selection on the estimation of the program effects is negligible. More importantly, the regression results indicate that persons with AIDS who use waiver services incur monthly Medicaid expenditures that are on average 22% to 27% lower than otherwise similar nonparticipants.


CONCLUSIONS
These results, based on the first 2 years that Project AIDS Care was operational, suggest that home and community-based care for AIDS patients results in lower expenditures per beneficiary.
Anderson
K H
KH
Department of Economics and Business Administration, Vanderbilt University, Nashville, TN 37235, USA.
Mitchell
J M
JM
D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D003363:Cost Control; D005260:Female; D005431:Florida; D015658:HIV Infections / Q000191:economics*; D005102:Health Expenditures; D006297:Health Services Accessibility; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D007344:Insurance Claim Reporting; D008297:Male; D008484:Medicaid / Q000458:organization & administration*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012044:Regression Analysis; D014481:United States