Variation by Disability in State Predictors of Medicaid 1915c Waiver Use and Expenditures

Purpose: States are increasingly using the Medicaid 1915c waiver program to provide community-based long-term care. A substantially greater share of long-term-care dollars supports community-based care for individuals with intellectual and developmental dis-abilities, relative to older and working-age persons with primarily physical disabilities. Design and Methods: We used state-level data for the period from 1992 to 2001 to estimate fixed-effects panel models. We compared state predictors of waiver utilization and expenditures for waivers serving both older and working-age individuals (O/WAIs) relative to waivers serving individuals with intellectual and developmental disabilities (IDDs). Results: We found community-based-care capacity to predict use and expenditures for both target groups. Although regulation of institutional supply was positively re-lated to expenditure measures for IDDs, it was not related to use or expenditures for O/WAIs. Demand variables (e.g., the size of a state’s African American population) predicted use and expenditures for IDD waivers, but they were less consistent for O/WAI waivers. State resources were a robust predictor of use and expenditures for both groups. Implications: In-creased community-based-care capacity appears to be an important factor in efforts to expand the availability of Medicaid community-based care. Federal policies that address state resource issues may also spur growth in community-based long-term care. Key Words: Home- and community-based care, Long-term care, State variation, State policy