Association for Public Policy Analysis & Management

State Medicaid boasts the only publicly funded long-term care program in the United States.  Indigent Americans who require a qualifying amount of support can receive care in a nursing home or can apply for a waiver to access needed care in a community-setting. While each waiver program is a unique construction of the state that operates it, all states manage the growth of waiver programs by restricting participation through funding caps or through limits placed on the number of program recipients. While waiver distribution policies are set at the state level and approved by the federal Center for Medicare and Medicaid Services, they are implemented at the local level through a system of catchment areas.  

This paper explores the distribution of Medicaid long-term care services and compares both the allocation of Medicaid long-term care waivers and the supply of Medicaid-funded nursing home beds against relevant metrics of need in those counties. Data includes a metric of need constructed from the American Community Survey as well as information from the Centers for Medicaid and Medicare Services.  Dependent variables include waiver payment data from the Georgia Division of Aging Service and nursing home data from the Georgia Department of Community Health Nursing Facility Survey.

Preliminary findings suggest that the distribution of public nursing home services are not sensitive to most metrics of community-wide need.  However both variables showed strong negative relationships with population size. Significant relationships also existed between waiver services and the proportion of the population living below poverty, the percentage of the population enrolled in Medicare and a negative relationship with the proportion of women in the workforce.   

Due to the rationing of Medicaid waiver supports, it is critical to understand the factors that predict their distribution in order to guard against implementation policies which create systematic barriers to groups of qualified individuals. This research represents an initial foray into the construction of a model.  It suggests that there are some explanatory factors which can predict the distribution of public long-term care services, however further research is needed to discover missing factors and to link particular implementation policies and procedures to observed access and uptake.