Factors associated with state adoption of the 1915(i) state plan and 1915(k) community first-choice Medicaid home and community-based services programs

ABSTRACT The COVID-19 pandemic has had serious consequences for older adults and individuals with chronic conditions, many of whom rely on long-term services and supports. In response to the pandemic, the federal government invested nearly $13 billion dollars for states to expand home and community-based services (HCBS) for older adults and persons with disabilities. States have several options to provide Medicaid-funded HCBS benefits including the 1915(i) HCBS benefit and 1915(k) Community First Choice program. This research uses event history analysis to model state adoption of these two optional Medicaid benefits. The results indicate that a Democratic governor and the state’s unemployment rate were associated with states’ adoption of the 1915(k) program, while the unemployment rate and the supply of home health agencies were associated with states’ adoption of the 1915(i) benefit. Findings highlight similarities in factors associated with Medicaid HCBS program adoption as well as differences stemming from unique program attributes.