Use of Medicaid 1915(c) home- and community-based care waivers to reconfigure state long-term care systems

Med Care Res Rev. 2001 Mar;58(1):100-19. doi: 10.1177/107755870105800106.

Abstract

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.

MeSH terms

  • Aged
  • Community Health Services / economics
  • Community Health Services / supply & distribution
  • Demography
  • Health Expenditures / classification
  • Health Expenditures / statistics & numerical data*
  • Health Services Needs and Demand
  • Home Care Services / economics
  • Home Care Services / supply & distribution
  • Humans
  • Long-Term Care / economics*
  • Medicaid / legislation & jurisprudence
  • Medicaid / statistics & numerical data*
  • Multivariate Analysis
  • Politics
  • Socioeconomic Factors
  • State Health Plans / economics*
  • United States