State Medicaid Budgeting in Hard Times: Implications for Long-Term Care

This qualitative analysis compares the annual Medicaid budgeting processes in Utah and Illinois from the late 1970s until 1985, explaining why Utah cut the proportion spent on nursing homes and Illinois did not. It posits rational, organizational, and political process interpretations of each state's choices. The states implemented Medicaid rationing (through preadmission screening, rate freezes and adjustments, and expansion of alternatives) in significantly different ways. Utah reduced utilization of nursing homes while Illinois contained rates. Such diverse policy choices have aggravated disparities among the states in access to and quality of long-term care. Rational planning for our aging society will have to overcome these growing disparities among state policies.