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J Health Soc Policy. 2006;22(2):31-50.

Institutional and community-based long-term care: a comparative estimate of public costs.

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  • 1Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California Street, Suite 455, San Francisco, CA 94118, USA.


As long-term care policy makers struggle with competing challenges including state budget deficits and pressures to expand homeand community-based services (HCBS), there is a pressing need for information on the comparative cost of Medicaid HCBS and institutional care. This paper uses the most recent available data (2002) to present three per participant expenditure comparisons between Medicaid HCBS waivers (which require that participants have an institutional level of care need) and institutional care: (1) program expenditure (waivers vs. the comparable level of institutional provision); (2) total Medicaid expenditure (program plus other Medicaid expenditure); and (3) estimated total public expenditure (Medicaid expenditures plus state and federal supplemental- income payments). This analysis estimates that when compared with Medicaid institutional care in 2002, HCBS waivers produced a national average public expenditure saving of $43,947 per participant. doi:10.1300/J045v22n02_03.

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