Rationing Rights: Administrative Burden in Medicaid Long-Term Care Programs.

Area of Science:

• Public Health
• Health Services Research
• Disability Studies

Background:

• Medicaid waivers offer community-based support for disabled individuals as an alternative to institutionalization.
• Waiver programs are not entitlements, meaning eligibility does not guarantee services.
• States employ bureaucratic procedures to manage and limit access to these conditional rights.

Purpose of the Study:

• To analyze how states use administrative procedures to ration access to Medicaid home- and community-based services.
• To investigate the mechanisms by which eligible disabled individuals are denied or delayed access to waiver programs.

Main Methods:

• Analysis of primary and secondary data on state Medicaid waiver programs.
• Documentation of state administrative procedures impacting access to services.

Main Results:

• Complex waiver programs create indirect burdens, increasing costs and hindering eligibility.
• Direct rationing occurs through waitlists and prioritization of eligible individuals.
• Opaque administrative processes and burdens disproportionately impact marginalized groups, concealing rationing strategies.

Conclusions:

• Administrative burdens obstruct disabled individuals' right to community living under the ADA.
• The opaqueness of waiver programs serves to conceal rationing, contributing to inequality.
• Bureaucratic procedures effectively manage access while obscuring the underlying reasons for service limitations.