title: Strengthening home and community-based care through Medicaid waivers.
abstract: States are increasingly using the Medicaid 1915c waiver program to provide community-based long-term care (LTC). We examined state predictors of waiver utilization and expenditures for waivers serving both older and working-age individuals. State level data for the period 1992 to 2001 were used to estimate random effects panel models. States with increased community-based care (e.g., home health agencies) and decreased nursing home bed capacity were positively associated with state per capita rates of use, expenditures, and the share of Medicaid LTC dollars supporting 1915c waivers. States appeared to substitute Medicare for Medicaid services for individuals eligible for both. State per capita income was positively related to each measure. State policies that facilitate decreased institutional and increased community- based capacity appear essential to state efforts to expand access to community-based services. Federal policies that address state resource issues may also spur growth in community-based LTC, which, in most states, continues to be limited.
authors.affiliation: Department of Public Policy, University of Maryland, 1000 Hilltop Circle, Baltimore, MD 21250, USA. nanmille@umbc.edu
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Miller
authors.forename: Andrea
authors.initials: A
authors.lastname: Rubin
authors.forename: Keith T
authors.initials: KT
authors.lastname: Elder
authors.forename: Martin
authors.initials: M
authors.lastname: Kitchener
authors.forename: Charlene
authors.initials: C
authors.lastname: Harrington
mesh_terms: D000328:Adult; D000368:Aged; D003153:Community Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D004608:Eligibility Determination / Q000331:legislation & jurisprudence*; D005544:Forecasting; D006297:Health Services Accessibility / Q000191:economics*; D006301:Health Services Needs and Demand; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care / Q000191:economics*; D008484:Medicaid / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D012044:Regression Analysis; D012959:Socioeconomic Factors; D013221:State Health Plans / Q000331:legislation & jurisprudence*; D014481:United States