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

Abstract

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.

Relations Among Home- and Community-Based Services Investment and Nursing Home Rates of Use for Working-Age and Older Adults: A State-Level Analysis

“…I divided expenditures for HCBS services, including home health, personal care, and 1915(c) waivers, by total LTC expenditures, similar to a measure of relative investment used in previous work. 8,9,11,14 I expected a relatively greater investment in HCBS over the study period to be associated with lower rates of nursing home use. Use of the share allocated to HCBS is a way to gauge the relative reallocation to HCBS from institutional care.…”

Examining the formation of Medicaid elderly 1915(c) waivers

“…The studies have focused on different groups of 1915(c) waiver participants, including those with ID/DD, the aged and physically disabled, and total 1915(c) waiver participants. The findings from these studies have been consistent, suggesting that state demographics, market demand and supply, Medicaid program characteristics (i.e., "medically needy" income thresholds), and political ideology influence the number of 1915(c) waiver participants states have and the amount states spend on 1915(c) waiver programs (Harrington et al, 2002;Kitchener et al, 2004Kitchener et al, , 2007Kitchener et al, 2005;LeBlanc et al, 2000;N. A. Miller, Elder, Kitchener, Kang, & Harrington, 2008;N.…”

“…The basic policy systems model was later expanded by Dye (1966) & Berry, 1990;Harrington et al, 2000;Hays & Glick, 1997;Kitchener, Carrillo, & Harrington, 2003;Matisoff, 2008;E. A. Miller, 2006b;N. A. Miller et al, 2008;N.…”

“…Following Berry and Berry (1990) work has found that larger states with greater income provide more coverage of HCBS through Medicaid (Harrington et al, 2000;N. A. Miller et al, 2008), I suspect that states with larger populations and more income will be more likely to adopt elderly waivers and have waivers of higher quality with more participants and expenditures.…”

“…hypothesize that neighboring state elderly waiver policy will positively influence state decisions to adopt elderly waiver and elderly waiver program quality and size (N. A. Miller et al, 2008;B. S. Nelson, 2007).…”