Assistive technology in medicaid home- and community-based waiver programs.
OBJECTIVE
As consensus emerges concerning the need to extend publicly funded home- and community-based services that support the independence of seniors, studies have reported the efficacy and cost effectiveness of assistive technology (AT). This article presents the latest available national AT expenditure and participation trends (1999-2002) for Medicaid 1915(c) waivers, the largest Medicaid home- and community-based service program.


METHODS
We collected annually reported Centers for Medicare and Medicaid Form 372 data from state officials for each waiver providing AT for the period from 1999 to 2002. Descriptive statistics examined trends in national participation and expenditures, interstate variations in participation and expenditures, and differences in provision between elderly persons and persons with developmental disabilities.


RESULTS
Although we report a rise in the number of waivers providing AT, there has been much slower participant growth compared with the broader waiver program, and there is wide interstate variation in waiver AT provision. Not only do most waivers with AT serve persons with developmental disabilities, AT spending for that target group is almost twice that for aged or disabled waiver participants.


CONCLUSIONS
This study highlights three policy concerns: first, the large interstate variations in AT provision in Medicaid waivers may signal access problems in some states; second, policy choices in some states may favor Medicaid spending on AT for the developmental disability population over that for the elderly population; and third, data limitations prevent a comparable state-by-state analysis of Medicare AT provision.
Kitchener
Martin
M
Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California Street, Suite 455, San Francisco, CA 94118, USA.
Ng
Terence
T
Lee
Hyang Yuol
HY
Harrington
Charlene
C
D000203:Activities of Daily Living; D003153:Community Health Services / Q000191:economics*; D019992:Databases as Topic; D005102:Health Expenditures / Q000639:trends; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008484:Medicaid; D012051:Reimbursement Mechanisms; D012656:Self-Help Devices / Q000191:economics*; D013221:State Health Plans; D014481:United States