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.
Miller
N A
NA
University of Maryland, Baltimore County, USA.
Ramsland
S
S
Goldstein
E
E
Harrington
C
C
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