弃权
医疗补助
背景(考古学)
官僚主义
业务
定量配给
国家(计算机科学)
政治
公共行政
政治学
法学
医疗保健
算法
计算机科学
生物
古生物学
作者
Pamela Herd,Rebecca A. Johnson
出处
期刊:Journal of Health Politics Policy and Law
[Duke University Press]
日期:2024-09-27
标识
DOI:10.1215/03616878-11567708
摘要
Abstract Context: States use Medicaid waivers to provide supports for disabled people in communities, rather than in institutions. Because waivers are not entitlements, those deemed eligible are not guaranteed these supports. How do states, in practice, use bureaucratic procedures to ration this ‘conditional’ right? Methods: Drawing on primary and secondary data, we analyze waiver programs, and document state administrative procedures to indirectly and directly ration access. Findings: Burdens indirectly limit disabled peoples' access to Medicaid home and community-based services, via a complex array of waiver programs that exacerbate costs associated with gaining eligibility, and directly limit access, via waitlists and prioritization among the eligible. There is also evidence that states strategically deploy opaqueness to provide political cover for unpopular waitlists. The overall process is opaque, confusing, and time intensive, with burdens falling hardest on marginalized groups. Conclusions: Administrative burdens impede the right to live in the community afforded to people with disabilities under the American with Disabilities Act. The opaqueness and associated burdens with waiver programs are a way to conceal these costs, thereby demonstrating how burdens “neatly carry out the ‘how’ in the production of inequality, while concealing . . . the why.”
科研通智能强力驱动
Strongly Powered by AbleSci AI