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State-level Medicaid 1915(c) home and community-based services waiver support for caregivers

      Highlights

      • Caregivers are performing complex nursing care procedures for care recipients.
      • Caregivers experience unintended consequences due to their role.
      • State-level Medicaid waivers can offer supportive services for caregivers.
      • State-based Medicaid waiver services for caregivers vary widely.
      • Knowledge of caregiver supports informs evidence-based policy advocacy.

      Abstract

      Background

      Informal caregivers encounter emotional distress, worsening personal health, and financial strain. The Medicaid 1915(c) Home and Community-Based Services (HCBS) waiver programs provide an array of services including support for caregivers.

      Purpose

      This policy analysis examined Medicaid waiver services offered to persons 65 and older among the 50 states and District of Columbia (DC).

      Methods

      Data were obtained from Medicaid waiver applications for adults age 65 and older available at Medicaid.gov. Data elements included number of waiver programs and services for supporting caregivers. Descriptive statistics were applied.

      Findings

      Forty-three states including DC (84%) offered a Medicaid waiver for older adults; seven states (14%) offer two waiver programs; eight states (16%) had no Medicaid waiver. Payment to a relative or legal guardian caregiver was the most common service offered in 39 (76%) states. Other services included in-home respite care and adult day health care (35 states; 67%), out-of-home respite care (32 states; 63%), skilled nursing (28 states; 55%), paid spousal caregivers (18 states; 35%), caregiver training (15 states; 29%), and adult day care for socialization (7 states, 14%).

      Discussion

      This study identifies wide variability in caregiver support across state-based Medicaid waivers. Future research should evaluate effectiveness of the waiver programs in supporting caregivers and inform evidence-based policy advocacy for supporting caregivers.

      Keywords

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