Abstract:

The Arizona Long-Term Care System is the first capitated, long-term Medicaid program in the Uinted States to operate statewide. It promotes an extensive home and community-based services program intended to lower long-term care costs by replacing home care with institutional care. This article describes the research strategy, statistical methods, and results of evaluating the Arizona Long-Term Care System's success in using home and community care to avoid nursing home expenditures. A particular focus of the article is the methodology employed as a substitute for a randomized controlled trial. Finding a control group was not possible because of the programs statewide implementation. The discussion section presents the authors views of the elements of the program that may have been critical to its success. Details of two aspects of the evaluation methodology are presented in the appendix.