Abstract
The Patient Protection and Affordable Care Act (ACA) included new optional Medicaid home and community-based (HCBS) initiatives: the Balancing Incentive Program, the 1915(k) Community First Choice personal care benefit, and the revised 1915(i) state plan benefit. This study identifies political, economic, programmatic, and intergovernmental factors that facilitated or impeded state participation in these ACA programs. Longitudinal and cross-sectional regression analyses were used to model state adoption from 2011 to 2015. Findings indicate that political ideology, economic factors, and existing HCBS policies were the most important determinants of whether a state adopted the ACA’s HCBS opportunities. This research has implications for federal officials interested in spurring states to achieve greater rebalancing of Medicaid long-term services and supports toward HCBS.
- © 2020 Russell Sage Foundation. Beauregard, Lisa Kalimon, and Edward Alan Miller. 2020. “Why Do States Pursue Medicaid Home Care Opportunities? Explaining State Adoption of the Patient Protection and Affordable Care Act’s Home and Community-Based Services Initiatives.” RSF: The Russell Sage Foundation Journal of the Social Sciences 6(2): 154–78. DOI: 10.7758/RSF.2020.6.2.07. The authors acknowledge the University of Massachusetts Boston Doctoral Dissertation Grant program and the Department of Public Policy for providing funding for this research. The authors would also like to thank the editors and participants at the Russell Sage Foundation’s Social, Political, and Economic Effects of the Affordable Care Act conference for their invaluable insights. Direct correspondence to: Lisa Kalimon Beauregard at lkalimon{at}gmail.com, Massachusetts Executive Office of Elder Affairs, One Ashburton Place, 5th Floor, Boston, Massachusetts 02108.
Open Access Policy: RSF: The Russell Sage Foundation Journal of the Social Sciences is an open access journal. This article is published under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.