Why Do States Pursue Medicaid Home Care Opportunities? Explaining State Adoption of the Patient Protection and Affordable Care Act's Home and Community-Based Services Initiatives

The Patient Protection and Affordable Care Act (ACA) included new optional Medicaid home and community-based (HCBS) initiatives: the Balancing Incentive Program, the 1915(k) Community First Choice personal care benefit, and the revised 1915(i) state plan benefit. This study identifies political, eco...

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Bibliographic Details
Published in:RSF : Russell Sage Foundation journal of the social sciences 2020-07, Vol.6 (2), p.154-178
Main Authors: Beauregard, Lisa Kalimon, Miller, Edward Alan
Format: Article
Language:English
Subjects:
Activities of daily living
affordable care act
Americans with Disabilities Act 1990-US
Community
Community-based programs
Cost control
Developmental disabilities
Economic factors
home and community-based services
Home health care
Medicaid
National plans
Nursing
Older people
Part II. State Decisions and Their Impacts
Patient Protection & Affordable Care Act 2010-US
Patient safety
Patients
Personal grooming
Political ideologies
Provisions
state policy adoption
Support services
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Summary:The Patient Protection and Affordable Care Act (ACA) included new optional Medicaid home and community-based (HCBS) initiatives: the Balancing Incentive Program, the 1915(k) Community First Choice personal care benefit, and the revised 1915(i) state plan benefit. This study identifies political, economic, programmatic, and intergovernmental factors that facilitated or impeded state participation in these ACA programs. Longitudinal and cross-sectional regression analyses were used to model state adoption from 2011 to 2015. Findings indicate that political ideology, economic factors, and existing HCBS policies were the most important determinants of whether a state adopted the ACA's HCBS opportunities. This research has implications for federal officials interested in spurring states to achieve greater rebalancing of Medicaid long-term services and supports toward HCBS.
ISSN:2377-8253
2377-8261
DOI:10.7758/rsf.2020.6.2.07