全球智库信息集成服务系统

Interstate variations in reliance on HCBS compared to institutional care are partly due to some states having committed more strongly to the goal than others and having accordingly made greater efforts to “rebalance.” However, states also experience differential advantages or handicaps that make rebalancing easier or more difficult for some compared to others. The factors that make rebalancing easier or more difficult vary in malleability; that is, the extent to which state policymakers can exercise control over them. In contrast, other factors hypothesized to influence rebalancing toward greater reliance on HCBS are at least somewhat under state control. In this study, we use data from the Medicaid Analytic eXtract, the American Community Survey, and a variety of data sources describing state characteristics and policies to quantify interstate variations in Medicaid LTC systems performance and to explore and begin to test hypotheses about the factors that explain greater or lesser use of HCBS across states and subpopulations. Our findings are based on data from 39 states and the District of Columbia and represent Medicaid service use and expenditures in calendar year 2006.