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Use of Medicaid 1915(c) Home- and Community-Based Care Waivers to Reconfigure State Long-Term Care Systems

University of Maryland, Baltimore County

Sarah Ramsland

University of Maryland, Baltimore County

Elizabeth Goldstein

Health Care Financing Administration

Charlene Harrington

University of California, San Francisco

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.

Medical Care Research and Review, Vol. 58, No. 1, 100-119 (2001)
DOI: 10.1177/107755870105800106


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