AIDS Home- and Community-Based Waivers: Effects on Use of Services, Expenditures, and Survival

Abstract

State Medicaid home- and community-based waiver programs for persons with AIDS (PWAs) were implemented with the expectation that PWAs would use these services in lieu of more expensive hospital-based care. If so, Medicaid spending per PWA should decline, and program costs fall. We analyze Florida Medicaid claims data for PWAs from December 1995 through December 1997 to determine how participation in the waiver program affects the use of inpatient services, the receipt of antiretroviral combination therapies (available to Medicaid recipients throughout the study period), monthly expenditures, and survival of PWAs. We find that waiver participants are more likely to receive combination therapies but less likely to use hospital-based care than nonparticipants; white men and sicker patients are more likely to join the waiver program than other eligible PWAs; monthly expenditures for waiver participants are 52% lower than for nonparticipants; and waiver participation does not affect survival.