Rationing Rights: Administrative Burden in Medicaid Long-Term Care Programs.
Context: States use Medicaid waivers to provide supports for disabled people in communities rather than in institutions. Because waivers are not entitlements, those deemed eligible are not guaranteed these supports. How do states, in practice, use bureaucratic procedures to ration this "conditional"...
| Publicado en: | Journal of Health Politics, Policy & Law Vol. 50; no. 2; pp. 223 - 252 |
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| Autores principales: | , |
| Formato: | Artículo |
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Duke University Press
Apr2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=183256082&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 183256082 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 03616878 HPP jtl: Journal of Health Politics, Policy & Law issn: 03616878 maglogo: N pubinfo: dt: Apr2025 vid: 50 iid: 2 pid: 154 pub: Duke University Press artinfo: ui: 183256082 10.1215/03616878-11567708 ppf: 223 ppct: 29 formats: tig: atl: Rationing Rights: Administrative Burden in Medicaid Long-Term Care Programs. aug: au: Herd, Pamela Johnson, Rebecca A. affil: University of Michigan Georgetown University su: United States Medicaid law Health services accessibility Community health services Managed care programs State governments Human rights Associations, institutions, etc. Needs assessment Health care rationing People with disabilities Medical care costs Long-term health care Descriptive statistics Eligibility (Social aspects) sug: subj: Medicaid law Health services accessibility Community health services Managed care programs State governments Human rights Associations, institutions, etc. Needs assessment Health care rationing People with disabilities Medical care costs United States Other Similar Organizations (except Business, Professional, Labor, and Political Organizations) Community health centres All Other Outpatient Care Centers Residential Mental Health and Substance Abuse Facilities Other Individual and Family Services Other local, municipal and regional public administration Administration of Human Resource Programs (except Education, Public Health, and Veterans' Affairs Programs) Long-term health care Descriptive statistics Eligibility (Social aspects) keyword: disability inequality long-term care Medicaid disability inequality long-term care Medicaid ab: Context: States use Medicaid waivers to provide supports for disabled people in communities rather than in institutions. Because waivers are not entitlements, those deemed eligible are not guaranteed these supports. How do states, in practice, use bureaucratic procedures to ration this "conditional" right? Methods: Drawing on primary and secondary data, the authors analyze waiver programs and document state administrative procedures that indirectly and directly ration access. Findings: Burdens indirectly limit disabled people's access to Medicaid home- and community-based services via a complex array of waiver programs that exacerbate costs associated with gaining eligibility. In addition, burdens directly limit access via wait lists and prioritization among the eligible. There is also evidence that states strategically deploy opaqueness to provide political cover for unpopular wait lists. The overall process is opaque, confusing, and time intensive, with burdens falling hardest on marginalized groups. Conclusions: Administrative burdens impede disabled people's efforts to exercise their right to live in the community as afforded to them under the American with Disabilities Act. The opaqueness and associated burdens with waiver programs are a way to conceal these burdens, thereby demonstrating how burdens "neatly carry out the 'how' in the production of inequality, while concealing... the why" (Ray, Herd, and Moynihan 2023: 139). pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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