Use of Medicaid 1915(c) home- and community-based care waivers to reconfigure state long-term care systems.
Since Congressional authorization in 1981, Medicaid 1915(c) home- and community-based care waivers have influenced states' efforts to transform their long-term care systems. In 1997, every state participated in the 1915(c) waiver program, while waiver expenditures, at $8.1 billion, represented 59.6 percent of all Medicaid community-based care expenditures. To explore state-level factors that appear related to these expenditures, the authors turn to a body of work on Medicaid resource allocation. They compare the influence of five factors--sociodemographic, supply, economic, programmatic, and political environment--on states' allocations to long-term care expenditures and 1915(c) waiver expenditures. The state economic environment was an important influence on total, as well as waiver expenditures. State regulation of long-term care supply demonstrated the most substantive relationship, increasing the share of dollars supporting 1915(c) waivers from 11.6 to 20.0 over the study period, all else equal.
University of Maryland, Baltimore County, USA.
N A
NA
Miller
S
S
Ramsland
E
E
Goldstein
C
C
Harrington
D000368:Aged; D003153:Community Health Services / Q000191:economics / Q000600:supply & distribution; D003710:Demography; D005102:Health Expenditures / Q000145:classification / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006699:Home Care Services / Q000191:economics / Q000600:supply & distribution; D006801:Humans; D008134:Long-Term Care / Q000191:economics*; D008484:Medicaid / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D011057:Politics; D012959:Socioeconomic Factors; D013221:State Health Plans / Q000191:economics*; D014481:United States