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Medicaid home and community-based services: national program trends
Martin Kitchener1, Terence Ng, Nancy Miller
1Department of Social and Behavioral Sciences, University of California, San Francisco (UCSF), USA. martink@itsa.ucsf.edu
Health Affairs (Project Hope)
|January 14, 2005
Summary
Medicaid home and community-based services (HCBS) show slowing growth and varied cost controls. Policymakers grapple with rising institutional care costs and expanding HCBS access.
Area of Science:
- Health Policy
- Public Health
- Gerontology
Background:
- Medicaid long-term care (LTC) spending is dominated by institutional care costs.
- Policymakers face pressure to increase home and community-based services (HCBS) within Medicaid.
- Significant interstate variations exist in Medicaid's provision of LTC services.
Purpose of the Study:
- To present current program trends in Medicaid HCBS.
- To report on cost control policies in Medicaid waiver programs.
- To analyze interstate variations in Medicaid LTC service provision.
Main Methods:
- Analysis of national program trends in three Medicaid HCBS programs: waivers, home health, and state-plan personal care.
- A national survey of cost control policies implemented in Medicaid waiver programs in 2002.
Main Results:
- Annual participation growth rates in individual Medicaid HCBS programs are decelerating.
- Widespread use of cost containment strategies, including waiting lists, is evident in waiver programs.
- Substantial disparities persist across states in how Medicaid provides HCBS.
Conclusions:
- Medicaid HCBS are experiencing slower growth and increasing implementation of cost controls.
- Addressing rising institutional care costs while expanding HCBS requires careful policy consideration.
- Interstate variations highlight the need for standardized approaches to HCBS delivery and financing.