Citation

Miller, N.A., Harrington, C., Kitchener, M, Rubin, A. (2004, November 10). Predictors of 1915(c) Waiver Use for the Elderly, Working Age, and Individuals with Developmental Disabilities. Presented at the American Public Health Association 132nd Annual Meeting and Exposition hosted by American Public Health Association.

Summary

Wednesday, November 10, 2004 - 3:00 PM

Abstract #87011

Predictors of 1915(c) Waiver Use for the Elderly, Working Age, and
Individuals with Developmental Disabilities

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, email

Martin Kitchener, PhD, MBA, Department of Social & Behavioral Sciences,
University of California San Francisco, 3333 California St, Suite 455,
San Francisco, CA 94143-0612, email, 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 learn about state level factors that influence these trends and how
they differ by disability group.