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Uneven care across states

Disparities in Medicaid 1915(c) home and community‐based services waivers for older adults in the United States

Bibliographic Data

ID6430249
AuthorsHazal Swearinger (0000-0001-8573-641X, Social Work Çankırı Karatekin University Çankırı Turkey), Taryn Lindhorst (0000-0003-4613-6563, Social Work University of Washington Seattle Washington USA)
Year2025
Volume34
Issue2
Publication date2025-04-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueInternational Journal of Social Welfare (JOURNAL)
Journal identifiersISSN: 1369-6866 • E-ISSN: 1468-2397
PublisherWiley (PUBLISHER • GB)
DOI10.1111/ijsw.70015
OpenAlexW4409589469
LanguageEN
Citations received1
References cited31

The aging population in the United States, combined with older adults' strong preference for aging in place, has driven an increased demand for home and community‐based services (HCBS). Medicaid 1915(c) waivers are a critical component of the social welfare system, providing essential services such as homemaker services, personal care, and assistive technology to help economically vulnerable older adults with physical difficulties continue living in their homes. This study investigates state‐level differences in the availability, accommodation, and generosity of 1915(c) waivers for older adults. Data include approved state waiver applications, Genworth State Cost of Care, Medicare‐Medicaid Coordination Office reports, and the Medicaid Analytic Extract dataset. Findings reveal pronounced differences among states in these key areas. This study offers critical insights for policymakers, emphasizing the importance of expanding service variation, increasing slot allocation, incorporating participant direction more broadly, and enhancing generosity

Demographic economics · Economic growth · Economics · Health care · Medicaid · Political science · Employment and Welfare Studies · Historical Psychiatry and Medical Practices · Historical Studies on Reproduction, Gender, Health, and Societal Changes · Medicine · Gerontology

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Unique citing works1
Citations per year1
Citation span2026 - 2026 (1)
Citation velocitycurrent
Highly citedNo
Citation typesNeutral: 1

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