Use of Medicaid 1915(c) home- and community-based care waivers to reconfigure state long-term care systems

Since Congressional authorization in 1981, Medicaid 1915(c) home- and commu nity-based care waivers have influenced states' efforts to transform their long-term care systems. In 1997, every state participated in the 1915(c) wa iver program, while waiver expenditures, at $8.1 billion, represented 59.6 percent of all Medicaid community-based care expenditures. To explore state level factors that appear related to these expenditures, the authors turn to a body of work on Medicaid resource allocation. They compare the influen ce of five factors-sociodemographic, supply, economic, programmatic, and po litical environment-on states' allocations to long-term care expenditures a nd 1915(c) waiver expenditures. The state economic environment was an impor tant influence on total, as well as waiver expenditures. State regulation o f long-term care supply demonstrated the most substantive relationship, inc reasing the share of dollars supporting 1915(c) waivers from 11.6 to 20.0 o ver the study period, all else equal.