Medicaid Long-Term Community Care in California and Texas: A Growing Fiscal Challenge in a New Era

This study compares alternative approaches to providing community-based long-term care to low-income Medicaid eligible elders in California and Texas, two states with large Mexican-origin populations. As smaller families, the migration of children away from their parent’s communities, the need for women to work, and other factors undermine the family’s traditional role as the sole provider of all of the care an infirm elderly parent needs new experiments with publicly funded community care become necessary. Given the growing cost to states of Medicaid-financed long-term care various experimental Medicaid waiver programs have been introduced in both states. Yet the current mix of approaches to community care differs, with potentially significant implications for state expenditures, costs to families, and quality of life for elderly parents. While Texas has focused on consolidating most of its waiver programs into a single state wide capitated managed care program, California continues to experiment with a more diverse set of local programs. The chapter ends with a discussion of the implications of these differences for long-term care policy and the potential consequences of proposals by the current administration to give states more latitude in developing new approaches to offset the rising costs of Medicaid.