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Medical Care Research and Review
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Medicaid 1915(c) Waiver Use and Expenditures for Persons Living With HIV/AIDS

Nancy A. Miller

University of Maryland, Baltimore County

Keith T. Elder

University of Alabama, Birmingham

Martin Kitchener

Cardiff University, England

Yu Kang

University of Maryland, Baltimore County

Charlene Harrington

University of California, San Francisco

States' use of Medicaid 1915(c) waiver services for persons living with HIV/AIDS (PLWHA) has been limited. The authors examine state-level factors related to the decision to offer waiver services, as well as waiver use and expenditures in states offering waivers for PLWHA. They use fixed effects cross-sectional time series models to explore these state factors. States with Democratic governors were more likely to offer waiver services and were found to have higher rates of use and greater expenditures and to devote a larger share of long-term care dollars to waiver services for PLWHA. State supply of both institutional and residential care beds was negatively related to use and expenditures. Medicaid community-based care has been found to be related to improved outcomes and reduced costs of care. Ways to foster 1915(c) waiver expansion are important so as to increase access to care for PLWHA.

Key Words: home- and community-based care • Medicaid 1915(c) waivers • persons living with HIV/AIDS

This version was published on June 1, 2008

Medical Care Research and Review, Vol. 65, No. 3, 338-355 (2008)
DOI: 10.1177/1077558707312498
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