Medicaid Expansion: Policy Impact on Home and Community-Based Services

Medicaid Expansion: Policy Impact on Home and Community-Based Services

Mary Schmeida (Kent State University, Kent, USA) and Ramona McNeal (University of Northern Iowa, Cedar Falls, USA)
DOI: 10.4018/IJPPPHCE.2018070103
OnDemand PDF Download:
No Current Special Offers


U.S. longevity is placing a demand on long-term care services for the impaired and elderly. Medicaid is the primary insurance program in funding costly long-term care for the aged poor. As a major health reform law, the 2010 Patient Protection and Affordable Care Act, Public Law 111-148, gives financial incentive for states to expand Medicaid, transitioning long-term care services from costly facilities toward home and community-based care. Not all states choose to expand their Medicaid long-term care program despite the financial incentive, but instead they continue spending on nursing facility care despite the less costly option of community care. This article explores why some states have been reluctant to expand long-term care into the community. Regression analysis and 50 state-level data is used.
Article Preview

Policy Background

An examination of the timeline of the 1935 Social Security Act (SSA) and its amendments reveals how U.S. social policies have evolved into the modern-day health reform effort. Federal benefits for the aged did not become law until the Roosevelt Administration signing of the 1935 Social Security Act (Public Law 74-271, 1935). This Act (SSA) offered federal old age grants, helping states with provisions for “aged persons, blind persons, dependent and crippled children, maternal and child welfare, public health, and the administration of unemployment compensation laws, among other. It created the “Old-Age Reserve” account, now known as Social Security under its Title II. The nursing homes received the medical payments for care, not beneficiaries. This was a venue for today’s private nursing home industry because it prohibited social security money payout directly to recipients even though they were residing in the “poor homes” that were substandard (Public Law 74-271, 1935, pp. 620-622; Kaiser Family Foundation[KFF], August 2015, p. 1). Since inception, the SSA of 1935 has grown in scope. Medicare and Medicaid programs were added in 1965 (Public Law 89-97, 1965). Unlike Medicare that covers medical care for the aged, Medicaid is the U.S. social insurance program for the poor. As a redistributive program, it manipulates the allocation of property rights, wealth, and other value among social classes (Ripley & Franklin, 1980). Medicaid is a federal-state means tested insurance program (CMS, 2014), with the federal government giving states financial assistance (cost sharing) as an incentive to subsidize care and service its residents (Public Law 111-148, 2005). As an open-ended matching program, states must provide services for mandatory “categorically needy” populations, such as the aged, blind, and disabled to receive any federal matching funds (CMS, November 16, 2015, p. 24).

Complete Article List

Search this Journal:
Open Access Articles: Forthcoming
Volume 6: 2 Issues (2022): Forthcoming, Available for Pre-Order
Volume 5: 2 Issues (2021)
Volume 4: 2 Issues (2020)
Volume 3: 2 Issues (2019)
Volume 2: 2 Issues (2018)
Volume 1: 2 Issues (2017)
View Complete Journal Contents Listing