Journal article
The Affordable Care Act Community First Choice Option: Effect on Long-term Care Expenditures
Health services research, Vol.58(1), pp.154-163
02/2023
DOI: 10.1111/1475-6773.14063
PMCID: PMC9836960
PMID: 36085593
Appears in UI Libraries Support Open Access
Abstract
OBJECTIVETo empirically assess the effect of adopting ACA's Community First Choice option (CFC) on overall state home and community-based services (HCBS) expenditures as well as distribution of HCBS expenditures across different HCBS mechanisms. We also explore the heterogeneous effect of CFC across adopting states. DATA SOURCEWe used data from the Medicaid Long Term Services and Support (LTSS) expenditure reports prepared by Truven Analytics and Mathematica for the Center of Medicare and Medicaid Service (CMS) from 2008-2018 for all 48 states and the District of Columbia. STUDY DESIGNAn event-study difference-in-differences (DD) model was used to estimate the effect of CFC on HCBS expenditures using Medicaid LTSS expenditure reports from 2008-2018. We also employ the synthetic control method to unmask heterogeneity across CFC adopting states using data from 2008-2018. DATA COLLECTION/EXTRACTION METHODSNot applicable PRINCIPAL FINDINGS: Overall, CFC was not associated with a change in HCBS expenditures per capita or HCBS expenditures as a proportion of LTSS expenditures. However, there appears to be an increase in HCBS expenditures among states that were institutionally-oriented prior to CFC adoption. Additionally, CFC adoption was associated with an overall decrease in expenditures in alternative HCBS mechanisms (Personal Care Services State Plan Option and 1915(c) waivers), suggesting potential substitution across overlapping programs. CONCLUSIONResults indicate heterogeneity across states adopting CFC. More institutionally-oriented states appear to use CFC to expand HCBS. In contrast, more HCBS-oriented states appear to employ CFC to strategically restructure their overall portfolio and processes.
Details
- Title: Subtitle
- The Affordable Care Act Community First Choice Option: Effect on Long-term Care Expenditures
- Creators
- Onyinye OyekaKanika Arora
- Resource Type
- Journal article
- Publication Details
- Health services research, Vol.58(1), pp.154-163
- DOI
- 10.1111/1475-6773.14063
- PMID
- 36085593
- PMCID
- PMC9836960
- NLM abbreviation
- Health Serv Res
- eISSN
- 1475-6773
- Publisher
- Wiley
- Language
- English
- Electronic publication date
- 09/09/2022
- Date published
- 02/2023
- Academic Unit
- Health Management and Policy
- Record Identifier
- 9984297159802771
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