225316 Medicaid Home and Community Based Services: Programs and Policies, 1999-2007

Tuesday, November 9, 2010 : 11:24 AM - 11:42 AM

Terence Ng, MA , Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA
Charlene Harrington, PhD , Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA
In response to consumer demand, the Supreme Court decision in the Olmstead case and the New Freedom Initiative, states have unevenly expanded combinations of three Medicaid home and community based services (HCBS) : home health, state plan personal care services (PCS), and 1915(c) waivers. By 2007, the federal-state Medicaid program paid for 42 percent of the nation's estimated $190 billion total long-term care (LTC) expenditures while institutional care (e.g., nursing homes) consumed 58 percent of those expenditures. As states struggle with budget deficits in FY 2010 and beyond, the Deficit Reduction Act (2005) and the debate around health insurance reform reflects growing concerns about the need to preserve and expand Medicaid HCBS and the need for information on program and policy trends. This paper draws from a unique national dataset to present the latest trends in participants, expenditures and policies for the three Medicaid HCBS programs. While data for 2007 show a steady increase in participants and expenditures, these growth rates have slowed since 2001. Inequities in access to services and limited funds have also resulted in unmet needs for HCBS. Findings from the survey of policies such on the programs in 2009 show that states are increasing the number of waiting lists for waiver services even as the number of available “slots” increases. Cost caps such as service and cost limits are also used in almost half the state plan personal care programs and almost a third of home health programs.

Learning Areas:
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines
Public health or related public policy
Public health or related research
Social and behavioral sciences

Learning Objectives:
Identify trends in Medicaid HCBS participants, expenditures and policies; understand state responses to unmet needs and fiscal crisis in terms of Medicaid program trends and policy; and consider the potential impact on access to Medicaid HCBS through state policies

Keywords: Home Care, Long-Term Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an author on the research paper and am the primary researcher
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.