Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Health Management and Systems Sciences

Degree Program

Public Health Sciences with a specialization in Health Management, PhD

Committee Chair

Benitez, Joseph

Committee Co-Chair (if applicable)

Esterhay, Robert

Committee Member

Esterhay, Robert

Committee Member

Lorenz, Douglas

Committee Member

Taylor, James

Committee Member

Thornewill, Judah

Author's Keywords

LTSS; MLTSS; HCBS; comparative expenditure; long-term care; LTC; duals


This study compares total expenditures between beneficiaries enrolled in traditional Long-Term Care (LTC) and beneficiaries enrolled in Home and Community Based Services (HCBS) in a Quasi-Experimental Simple Ex Post Facto study utilizing multiple linear regression with inverted propensity score weighting. The results demonstrated, during the two years of the study period, that total expenditures were on average $14,565.03 (with a p-value oflessfor the total two years of the study, for HCBS beneficiaries when compared to their LTC counterparts. There remains today a belief that expenditures of elderly, dual beneficiaries electing to age-in-place for supported self-care expend less than that of elderly, dual beneficiaries electing traditional institutional LTC. Of forty-one peer reviewed periodicals, there is one that supports that belief, all other literature supports a counter-intuitive reality that LTC is less costly. In, Q4 of 2013 Florida’s Medicaid agency, the Agency for Health Care Administration (AHCA) in collaboration with the state’s Department of Elder Affairs (DOEA) consolidated its six aging/elderly programs[1] into their new Statewide Medicaid Managed Care (SMMC)-Long-Term Care (LTC) program. AHCA outsourced these programs through competitive procurement to managed care organizations. Compared to previous studies this study has three unique distinctions: Composition of expenditure categories–Nine of the eleven other studies compared only LTC costs directly to only HCBS costs. This study includes seven expenditure categories: Ancillary; Institutional–Acute; Institutional–Other; LTSS; Miscellaneous; Pharmaceutical; and, Professional. Managed care programs–Florida’s SMMC-LTC program is MLTSS with reimbursement methodologies including capitated payment schedules, FFS, pay-for-performance and risk/value agreements; and, Application of a Domicile Adjustment–In an attempt to adjust for Medicaid’s ‘room and board’ benefit differences between the two cohorts’, a domicile adjustment of -$831.00 was developed and applied to each month of enrollment for each LTC beneficiary. [1] The State of Florida had six different aging/elderly programs that were consolidated into the SMMC_LTC program, those six programs were: Nursing Facilities, Aged and Disabled Adult waiver, Assisted Living waiver, Nursing Home Diversion waiver, Channeling waiver and Frail Elder option.