The relationship between disability prejudice and medicaid home and community-based services spending.

Background: Medicaid is one of the most important health care safety nets for people with disabilities in the United States. Yet, from the beginning Medicaid only covered long-term services and supports (LTSS) through institutional care. In 1981 changes to Medicaid allowed states to provide home and community-based services (HCBS) instead so people with disabilities could receive LTSS in their own homes or in the community. As a result of these changes, there has been a significant decline in institutionalization of people with disabilities in favor of HCBS in the United States. However, the priority of HCBS can be impacted by ideas about community living and disability attitudes, among others. How these attitudes may trickle down to impact Medicaid funding decisions is unknown.

Objective: The aim of this study was to examine the relationship between HCBS and disability prejudice in the United States.

Methods: We used secondary data about state LTSS expenditures from across the nation in fiscal year (FY) 2015, as well as disability prejudice data (Disability Attitudes Implicit Association Test) from 325,000 people residing in all 50 states and the District of Columbia.

Results: Findings revealed regardless of the state size or wealth, states with more disability prejudice direct less of their LTSS funding towards HCBS.

Conclusions: Biases and prejudice in disability policy decision-making are obstacles to equality of opportunity and full participation in society, as promised by civil rights.