Recorded presentation

Nancy A Miller, PHD, Department of Public Policy, UMBC, 1000 Hilltop Circle, Baltimore, MD 21250, 410-455-3889, nanmille@umbc.edu, Charlene Harrington, PhD, Disability Statistics Center, Institute for Health & Aging, University of California, San Francisco, 3333 California Street, Room 340, San Francisco, CA 94118, Martin Kitchener, PhD, MBA, Department of Social & Behavioral Sciences, University of California San Francisco, 3333 California St, Suite 455, San Francisco, CA 94143-0612, and Andrea Rubin, MSW, Intercampus Doctoral Program in Gerontology, UMBC, Administration Building, Room 622, 1000 Hilltop Circle, Baltimore, MD 21250.

Although states have increased the availability of community based long term care through Medicaid 1915(c) waivers, there is considerable variability across states and, within states, by disability. In this presentation, we extend previous work to examine the factors related to rates of use in waivers serving older individuals and working age people with primarily physical disabilities (A/D) relative to waivers serving individuals with developmental disabilities (DD). We use a random effects panel model for the period 1992 through 2001, with the state as the unit of analysis. While rates of use increased in waivers serving each group, per capita rates of use on average increased 233% for waivers serving individuals with DD, compared to 139% for waivers serving the aged and disabled. Demand (e.g., the number of working age SSI recipients per capita), supply (e.g., residential care beds per capita) and fiscal support (e.g., per capita income) were related to increased rates of use for both target groups. Supply factors contributed substantially to both models. Per capita income, while significant as a predictor in both models, only improved the variance explained in the model for DD rates of use. Models for rates of use for individuals with DD explained greater variation overall (29.5% vs. 10.7%), as well as between states over time (18.3% vs. 2.7%). Policy implications are discussed.

Learning Objectives:

• To describe trends in state utilization rates for 1915(c) waivers serving the elderly, working age, and individuals with developmental disabilities
• To learnm about state level factors that influence these trends and how they differ by disability group

Keywords: Access to Care, Community-Based Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation