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Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit

Published on: September 30, 2020

Medicaid Long-Term Care: State Variation and the Intergovernmental Lobby.

Frank J Thompson¹, Joel C Cantor¹, Jennifer Farnham¹

¹Rutgers University.

Journal of Health Politics, Policy and Law

|April 30, 2016

Summary

Medicaid is crucial for long-term care (LTC) funding, but state commitment varies significantly. Federal policies have increased state control over these services, leading to disparities in Medicaid LTC access.

Keywords:

Medicaid long-term care intergovernmental lobby state variation

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Area of Science:

Health Policy
Public Health
Health Economics

Background:

Medicaid is the primary funder of long-term care (LTC) in the United States.
Significant state-level variations exist in Medicaid's commitment to funding LTC services.
Understanding the drivers of this variation is critical for addressing inequities.

Purpose of the Study:

To examine the extent of variation in state spending on Medicaid LTC.
To analyze the historical evolution of federal policies influencing state discretion in Medicaid LTC.
To explore policy options for mitigating inequities and assess future program sustainability.

Main Methods:

Analysis of state spending data on Medicaid long-term care.
Historical review of federal policies impacting state control over Medicaid services.
Assessment of the role of the intergovernmental lobby in shaping federal policy.

Main Results:

Federal policies over 50 years have increasingly granted states discretion over Medicaid LTC services.
State variation in Medicaid LTC commitment is substantial.
The intergovernmental lobby (governors, state officials) significantly influences federal policy, driving decentralization and state variation.

Conclusions:

Decentralization of Medicaid LTC policy, driven by the intergovernmental lobby, fuels state-level inequities.
While the lobby has supported Medicaid's growth, future erosion is possible.
Policy interventions are needed to address disparities in Medicaid LTC funding across states.