HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Harrington, C. Articles by LeBlanc, A. Search for Related Content PubMed PubMed Citation Articles by Harrington, C. Articles by LeBlanc, A.

Predicting State Medicaid Home and Community Based Waiver Participants and Expenditures, 1992–1997

^a Department of Social and Behavioral Sciences, University of California, San Francisco

Correspondence: Charlene Harrington, PhD, University of California, San Francisco, Laurel Heights Campus, Box 0612, San Francisco, CA 94143-0612. E-mail: chas{at}itsa.ucsf.edu.

Decision Editor: Laurence G. Branch, PhD

Purpose: The study examined trends and predictors of state Medicaid home and community based waiver participants and expenditures from 1992 to 1997 to identify factors of interest to policy makers and clinicians. Design and Methods: HCFA Form 372 data were collected from state officials for each waiver for each year. Two separate regression analyses were conducted to examine the effects of sociodemographic, economic, political, policy, and health services on state waiver participants and expenditures. Results: State waiver participants were positively associated with those aged 85 and over, personal income, residential care beds, and inpatient users and negatively with home health regulation and nursing home beds. State waiver expenditures were positively associated with democratic governors, personal income, home health reimbursement methods, Medicaid eligibility, home health agencies, and Medicare home health users. Implications: The factors policy makers might consider changing include increasing the number of residential care beds and home health agencies, removing certificate of need for home health care, using Medicare home health reimbursement methods for Medicaid, and raising the Medicaid eligibility criteria. In some states with low nursing home occupancy rates, reducing the supply of nursing home beds may also be considered. All of these approaches would be controversial and should be based on additional cost-effectiveness analysis.

Key Words: Medicaid • Home and community based services • Waivers

This article has been cited by other articles:

				N. A. Miller, K. T. Elder, M. Kitchener, Yu Kang, and C. Harrington Medicaid 1915(c) Waiver Use and Expenditures for Persons Living With HIV/AIDS Med Care Res Rev, June 1, 2008; 65(3): 338 - 355. [Abstract] [PDF]

				E. A. Miller Bureaucratic policy making on trial: medicaid nursing facility reimbursement, 1988-1998. Med Care Res Rev, April 1, 2006; 63(2): 189 - 216. [Abstract] [PDF]

				N. A. Miller, M. Kitchener, K. T. Elder, Y. Kang, A. Rubin, and C. Harrington Variation by Disability in State Predictors of Medicaid 1915c Waiver Use and Expenditures Gerontologist, December 1, 2005; 45(6): 764 - 772. [Abstract] [Full Text] [PDF]

				R. H. Fortinsky, J. R. Fenster, and J. O. Judge Medicare and Medicaid Home Health and Medicaid Waiver Services for Dually Eligible Older Adults: Risk Factors for Use and Correlates of Expenditures Gerontologist, December 1, 2004; 44(6): 739 - 749. [Abstract] [Full Text] [PDF]

				C. E. Bishop Paid Home Care in the 21st Century: Need and Demand Home Health Care Management Practice, August 1, 2004; 16(5): 350 - 359. [Abstract] [PDF]

				C. Harrington, J. T. Mullan, and H. Carrillo State Nursing Home Enforcement Systems Journal of Health Politics Policy and Law, February 1, 2004; 29(1): 43 - 74. [Abstract] [PDF]

				N. A. Miller, C. Harrington, S. Ramsland, and E. Goldstein State Policy Choices and Medicaid Long-Term Care Expenditures Research on Aging, July 1, 2002; 24(4): 413 - 444. [Abstract] [PDF]