4) Monday, November 8, 2004 - Board 2

Abstract #83483

Participant and expenditure trends in Medicaid 1915(c) HCBS waivers for
people living with HIV/AIDS

Terence Ng, MA, Dept of Social and Behavioral Sciences, University of California San Francisco, 3333 California Ave, Suite 455, San Francisco, CA 94118, (415) 502 6330, 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

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.

During the 1990s, in response to growing consumer demand and legal
pressures for Medicaid alternatives to institutional long-term care
(LTC), states steadily expanded 1915(c) Medicaid home and community based
services (HCBS) waiver programs to targeted populations including
HIV/AIDS and the elderly. These programs provide services such as
personal care and home modifications that enable participants to continue
living at home or in the community. It is known that while waiver
development has been uneven across the states, access has generally
improved for populations including the elderly and disabled. However,
less is known about the development of waivers targeted towards people
living with HIV/AIDS, even though they are recognized as an increasingly
popular option for people living with mid to advanced stages of HIV/AIDS
compared to institutional care. This paper uses a unique longitudinal
dataset to present the latest trend data (through 2002) on participants
and expenditures on Medicaid 1915(c) HCBS waivers for HIV/AIDS. The
findings indicate that against a background of state fiscal crises and
reduced growth rates on waivers in general, growth rates on HIV/AIDS
waivers have slowed at a faster rate. We then draw from a survey of all
states to examine the role of changing financial eligibility, and need
policies as well as expanding waiting lists to slow growth in HCBS
waivers targeted towards people living with HIV/AIDS.

Learning Objectives:

From this session participants will be able to: 1.identify trends in the
development (participants and expenditures) of Medicaid 1915(c) HCBS
waivers targeted towards people living with HIV/AIDS, 2. compare these
with participation and expenditure trends for HCBS waivers targeted
towards other populations (e.g., the elderly), 3. understand state
responses to fiscal crises in terms of Medicaid policy changes concerning
HIV/AIDS waivers, and 4.consider the potential impact on access to
Medicaid LTC services for people living with HIV/AIDS