1
|
Beauregard LK, Miller EA. A comparative analysis of state adoption of the Community First Choice program. Home Health Care Serv Q 2021; 40:177-191. [PMID: 34311673 DOI: 10.1080/01621424.2021.1947926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Over the last several decades, policymakers have focused on rebalancing Medicaid-funded long-term services and supports toward home and community-based services (HCBS). The Patient Protection and Affordable Care Act (ACA) included several opportunities for states to further promote HCBS options. One optional opportunity for states to expand Medicaid HCBS was the 1915(k) Community First Choice (CFC) program. To date, eight states have elected to add CFC as a Medicaid benefit. This study utilized comparative case studies to identify the factors that influenced states' adoption of CFC. Results highlight the important role that state bureaucrats, economic concerns, and existing HCBS programs had on states' decisions to adopt CFC.
Collapse
Affiliation(s)
- Lisa Kalimon Beauregard
- Massachusetts Executive Office of Elder Affairs Massachusetts Executive Office of Elder Affairs, Boston, Massachusetts, USA
| | - Edward Alan Miller
- Department of Gerontology, and Gerontology Institute, John W. McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA.,Department of Health Services Policy & Practice, and Faculty, School of Public Health, Brown University Providence, Rhode Island, USA
| |
Collapse
|
2
|
Wong YLI, Huangfu Y, Hadley T. Place and community inclusion: Locational patterns of supportive housing for people with intellectual disability and people with psychiatric disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 83:108-119. [PMID: 30193159 DOI: 10.1016/j.ridd.2018.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 07/05/2018] [Accepted: 08/20/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE This study examines the locational patterns of publicly-funded supportive housing for people with intellectual disability (people with ID) and people with psychiatric disorders (people with PD). METHODS Administrative data provided housing locations of 4599 people with ID and people with PD in one urban county and one suburban county in the United States. Census tract data captured neighborhood characteristics. Descriptive statistics and spatial analysis were used to analyze the distribution of supportive housing sites. RESULTS People with ID were more dispersed across a larger number of census tracts with smaller number of residents per tract than people with PD. While spatial dispersion in favor of people with ID was consistent across both counties, difference in dispersion was more pronounced in the urban county. People with PD were concentrated in neighborhoods with more socio-economic disadvantage, more residential instability, and a higher level of race/ethnic diversity than people with ID. CONCLUSION This study suggests that spatial-analytic method can serve as a useful tool for assessing the extent to which integrated housing is achieved for people with ID and people with PD. Interpretation of findings should be given due consideration of the policy context and neighborhood characteristics of the study communities.
Collapse
Affiliation(s)
- Yin-Ling Irene Wong
- School of Social Policy & Practice, University of Pennsylvania 3701 Locust Walk, Philadelphia, PA 19104-6214, USA.
| | - Yiyue Huangfu
- Department of Sociology, University of Wisconsin-Madison 1180 Observatory Drive, Madison, WI 53706-1393, USA.
| | - Trevor Hadley
- Center for Mental Health Policy and Services Research, University of Pennsylvania 3535 Market Street, 3/F, Philadelphia, PA 19104, USA.
| |
Collapse
|
3
|
Gravestock S. Developmental disabilities services in New York State. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.17.10.618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
4
|
Kitchener M, Ng T, Carrillo H, Miller N, Harrington C. Developing Personal Care Programs: National Trends and Interstate Variation, 1992–2002. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2016; 44:69-87. [PMID: 17583262 DOI: 10.5034/inquiryjrnl_44.1.69] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper examines the development of programs delivering personal care to the elderly and disabled. First, we report the latest national participant and expenditure trend data for the three main personal care programs: the Medicaid Personal Care Services (PCS) benefit, Medicaid 1915(c) waivers, and the Older Americans Act Title III. Second, to examine interstate variation revealed in the trend analysis, we present three time-series regression models of personal care development (expenditures, participants, and existence of PCS benefit) that control for state socioeconomic, political, policy, and provider characteristics. Positive predictors of personal care development include: percentages of population aged 85 and older, and nonwhite; per capita income; and liberal state politics. Negative predictors of personal care development include rates of Medicare home health users and hospital beds.
Collapse
Affiliation(s)
- Martin Kitchener
- Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California St., Suite 455, San Francisco, CA 94118, USA.
| | | | | | | | | |
Collapse
|
5
|
Cook JA, Jonikas JA. Self-Determination Among Mental Health Consumers/Survivors. JOURNAL OF DISABILITY POLICY STUDIES 2016. [DOI: 10.1177/10442073020130020401] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is well known that people with psychiatric disabilities lack self-determination in their lives. A number of studies have demonstrated the high rates of poverty experienced by many of these individuals, leading them to confront a variety of barriers to a higher quality of life. Moreover, concepts of self-determination and client control have not yet proliferated in the public mental health system. In spite of this, consumers/survivors have organized to demand their civil rights and full inclusion in making decisions regarding their own treatment. This article traces the history of self-determination for citizens with psychiatric disabilities, describes major barriers to self-determination, presents several theories of self-determination with potential relevance for mental health consumers/survivors, and offers ways in which self-determination and consumer control might be achieved both within and outside of service systems.
Collapse
|
6
|
Miller NA, Harrington C, Ramsland S, Goldstein E. State Policy Choices and Medicaid Long-Term Care Expenditures. Res Aging 2016. [DOI: 10.1177/01627502024004002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
State long-term care policies are directed toward a variety of goals. Concerns with expenditure control are primary. Certain states are also seeking to increase the availability of community-based care. A more balanced system would assist consumers in attaining valued goals, while being consonant with federal policy initiatives and legal rulings. The authors examine the relationship between state policies and Medicaid long-term care expenditures. These relationships are tested by multiple regression analysis, using a random effects model for 1991 through 1997. Prospective payment may moderate nursing facility expenditure growth and total long-term care expenditures. Institutional supply constraints demonstrated a positive relationship to both forms of community-based care expenditures. The authors found no evidence of Medicare maximization as a policy to constrain Medicaid expenditure growth. Finally, the authors note the importance of additional work in exploring the dynamics between state long-term care policies and expenditures for individuals with differing disabilities.
Collapse
|
7
|
Miller NA, Elder KT, Kitchener M, Yu Kang, Harrington C. Medicaid 1915(c) Waiver Use and Expenditures for Persons Living With HIV/AIDS. Med Care Res Rev 2007; 65:338-55. [DOI: 10.1177/1077558707312498] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
States' use of Medicaid 1915(c) waiver services for persons living with HIV/AIDS (PLWHA) has been limited. The authors examine state-level factors related to the decision to offer waiver services, as well as waiver use and expenditures in states offering waivers for PLWHA. They use fixed effects cross-sectional time series models to explore these state factors. States with Democratic governors were more likely to offer waiver services and were found to have higher rates of use and greater expenditures and to devote a larger share of long-term care dollars to waiver services for PLWHA. State supply of both institutional and residential care beds was negatively related to use and expenditures. Medicaid community-based care has been found to be related to improved outcomes and reduced costs of care. Ways to foster 1915(c) waiver expansion are important so as to increase access to care for PLWHA.
Collapse
Affiliation(s)
| | | | | | - Yu Kang
- University of Maryland, Baltimore County
| | | |
Collapse
|
8
|
Abstract
States play a principal role in designing and implementing publicly funded long term care programs. They are in a key position to determine what setting, from whom, and under what philosophy of care individuals can access long term care. State long term care systems have evolved over the past 25 years to support increased availability of community based care for older individuals. States have pursued three broad strategies to increase availability. One set of strategies aims to increase capacity through expanding the supply, public funding and eligibility for a wide array of home and community based services (HCBS). A second set of strategies seeks to constrain institutional growth in order to increase the dollars available for HCBS. Managed/capitated long term care is a third strategy that is a hybrid of the other two approaches. Empirically, increased capacity through use of Medicaid and Medicare resources and growth in the supply of community based care providers, combined with moderation of institutional bed supply, are associated with enhanced access and expenditures for community based long term care. The effectiveness of capitated or managed systems of care varies by model and in some cases is still under study. State fiscal resources are key to the ability to support community based care for the elderly. Targeted federal support may be critical to the continued expansion of community based care, given heterogeneity in state resources, coupled with an increasing demand for long term care.
Collapse
Affiliation(s)
- Nancy A Miller
- Department of Public Policy, University of Maryland, 1000 Hilltop Circle, Baltimore, MD 21250, USA.
| |
Collapse
|
9
|
Miller NA, Kitchener M, Elder KT, Kang Y, Rubin A, Harrington C. Variation by Disability in State Predictors of Medicaid 1915c Waiver Use and Expenditures. THE GERONTOLOGIST 2005; 45:764-72. [PMID: 16326658 DOI: 10.1093/geront/45.6.764] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE States are increasingly using the Medicaid 1915c waiver program to provide community-based long-term care. A substantially greater share of long-term-care dollars supports community-based care for individuals with intellectual and developmental disabilities, relative to older and working-age persons with primarily physical disabilities. DESIGN AND METHODS We used state-level data for the period from 1992 to 2001 to estimate fixed-effects panel models. We compared state predictors of waiver utilization and expenditures for waivers serving both older and working-age individuals (O/WAIs) relative to waivers serving individuals with intellectual and developmental disabilities (IDDs). RESULTS We found community-based-care capacity to predict use and expenditures for both target groups. Although regulation of institutional supply was positively related to expenditure measures for IDDs, it was not related to use or expenditures for O/WAIs. Demand variables (e.g., the size of a state's African American population) predicted use and expenditures for IDD waivers, but they were less consistent for O/WAI waivers. State resources were a robust predictor of use and expenditures for both groups. IMPLICATIONS Increased community-based-care capacity appears to be an important factor in efforts to expand the availability of Medicaid community-based care. Federal policies that address state resource issues may also spur growth in community-based long-term care.
Collapse
Affiliation(s)
- Nancy A Miller
- Department of Public Policy, University of Maryland, Baltimore County, Public Policy Building, 21250, USA.
| | | | | | | | | | | |
Collapse
|
10
|
Abstract
The American states exhibit considerable differences in health policy and market characteristics. Not only do they display substantial variation in spending, but they also display substantial variation in the strategies chosen to control costs, improve access, and ensure quality care. This article synthesizes studies that use 50-state statistical techniques to model policy adoption in the health sector. The purpose is to assess the strengths and weaknesses of this literature, to place it in the context of comparative state policy research generally, and to identify factors that best predict 17 health policy outcomes at the state level. A database was assembled containing 245 equations abstracted from 63 studies published between 1975 and 2002. Some predictors (such as income, aged population, public opinion, and nursing home beds) were studied much more frequently than others (e.g., education, divided government, federal Medicaid mandates, other states' adoptions). Results show that 43 of the 87 policy making determinants examined consistently predict two or more state-level outcomes, including four that predict five outcomes (non-white, urban, income, unemployment), two that predict six (tax capacity/effort, hospital beds), and two that predict seven (nursing home beds, liberal public opinion). Gaps are shown to exist in our understanding of the policy making effects of political system and intergovernmental characteristics.
Collapse
Affiliation(s)
- Edward Alan Millar
- A.Alfred Taubman Center for Public Policy and American Institutions, Brown University, RI 02912, USA.
| |
Collapse
|
11
|
Salem DA, Foster-Fishman PG, Goodkind JR. The adoption of innovation in collective action organizations. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2002; 30:681-710. [PMID: 12188056 DOI: 10.1023/a:1016373215689] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study used a quantitative/qualitative methodology to explore how collective action organizations (CAOs) remain open to organizational change and innovation. It examined the adoption of inclusion--a recent innovation in the field of disabilities--by local chapters of The Arc Michigan (a disabilities CAO). We found considerable variability in the adoption of inclusion by local Arc chapters. This variability was significantly related to the ecology surrounding these chapters. Local Arc chapters that had adopted an inclusion philosophy had significantly different internal and external environments from those that had not adopted inclusion. Our qualitative findings make it clear, however, that innovative Arc chapters were not the passive recipients of these internal and external influences. These chapters were proactive players in defining and shaping the nature of their internal and external environments. Strategies that were related to a chapter's ability to remain open to innovation included (a) a change orientation, (b) a conscious philosophy or vision, (c) a proactive strategy for achieving chapter goals and overcoming barriers to change, (d) the creation of a supportive organizational network, and (e) avoidance of resource dependencies that required them to engage in activities that were inconsistent with the innovation. These findings provide a framework by which CAOs can maintain an openness to innovation and remain on the forefront of social change.
Collapse
Affiliation(s)
- Deborah A Salem
- Department of Psychology, Michigan State University, East Lansing 48824-1117, USA.
| | | | | |
Collapse
|
12
|
Abstract
OBJECTIVE The authors explore state variation in expenditures for Medicaid community-based care services for the period 1990 to 1997. METHOD A random effects panel model is used to explore the relationship between state demographic, supply, economic, programmatic, and political factors and states' Medicaid community-based care expenditures. RESULTS Although states increased provision of services over the study period, significant state-level variation was evident. Expenditures were positively associated with state per capita income, regulation of nursing home bed supply, and the number of Medicare home health users but were negatively related to nursing home bed supply. CONCLUSIONS Recent legal rulings, combined with the demonstrated preferences of most individuals to receive care in the community, require policies to foster the expansion of Medicaid community-based care. The most consistent relationships that are amenable to policy intervention relate to state fiscal resources and long-term care supply regulation.
Collapse
|
13
|
Miller NA, Ramsland S, Goldstein E, Harrington C. Use of Medicaid 1915(c) home- and community-based care waivers to reconfigure state long-term care systems. Med Care Res Rev 2001; 58:100-19. [PMID: 11236230 DOI: 10.1177/107755870105800106] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Since Congressional authorization in 1981, Medicaid 1915(c) home- and community-based care waivers have influenced states' efforts to transform their long-term care systems. In 1997, every state participated in the 1915(c) waiver 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 influence of five factors--sociodemographic, supply, economic, programmatic, and political environment--on states' allocations to long-term care expenditures and 1915(c) waiver expenditures. The state economic environment was an important influence on total, as well as waiver expenditures. State regulation of long-term care supply demonstrated the most substantive relationship, increasing the share of dollars supporting 1915(c) waivers from 11.6 to 20.0 over the study period, all else equal.
Collapse
Affiliation(s)
- N A Miller
- University of Maryland, Baltimore County, USA
| | | | | | | |
Collapse
|
14
|
Rimmer JH, Braddock D, Pitetti KH. Research on physical activity and disability: an emerging national priority. Med Sci Sports Exerc 1996; 28:1366-72. [PMID: 8933486 DOI: 10.1097/00005768-199611000-00004] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Despite the voluminous amount of research that has been published in the field of exercise science over the past three decades, there remains a paucity of information on the activity patterns and physiological responses to exercise in persons with disabilities. In an era when physical activity has grown to new heights in terms of its importance in promoting health and preventing disease, many questions pertaining to how it affects the lives of individuals with physical disabilities remain unanswered. The purpose of this paper is to review the prevalence of disability in the United States and to present recommendations for future research on physical activity and disability. A related objective of this paper is to encourage exercise scientists to undertake research on this increasingly significant group of American citizens.
Collapse
Affiliation(s)
- J H Rimmer
- Research Unit, Institute on Disability and Human Development, University of Illinois at Chicago, USA
| | | | | |
Collapse
|