Medicaid community-based programs: a longitudinal analysis of state variation in expenditures and utilization

Area of Science:

• Health Services Research
• Public Health Policy
• Gerontology

Background:

• States face budget crises and increasing demand for home and community-based services (HCBS) within Medicaid.
• Understanding state-level variations in HCBS is crucial for effective policy and resource allocation.
• Medicaid HCBS programs include waivers, home health, and personal care services.

Purpose of the Study:

• To conduct a longitudinal analysis of state variations in expenditures and utilization for Medicaid HCBS programs.
• To identify sociodemographic, state policy, and market factors influencing HCBS participation and spending from 1992-1999.

Main Methods:

• Descriptive analysis of state variation in HCBS programs (waivers, home health, personal care) in 1999.
• Time-series regression models to assess factors associated with HCBS variation (1992-1999).
• Measures included participants per capita and expenditures per capita.

Main Results:

• Significant state-level variation observed in HCBS program participation and expenditures.
• Positive associations found between higher percentages of aged populations, per capita income, and the supply of home health agencies with HCBS participants and expenditures.
• Analysis identified key drivers of intra-state variation in waiver, home health, and personal care services.

Conclusions:

• State characteristics, including demographics and market supply, significantly influence Medicaid HCBS utilization and spending.
• Findings provide insights for states aiming to optimize HCBS program development and resource allocation.
• Policy implications for addressing budget constraints while expanding essential HCBS.