{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:33:06Z","timestamp":1787315586621,"version":"build-2736575974"},"reference-count":56,"publisher":"Duke University Press","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>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 \u201cconditional\u201d right?<\/jats:p>\n                  <jats:p>Methods: Drawing on primary and secondary data, the authors analyze waiver programs and document state administrative procedures that indirectly and directly ration access.<\/jats:p>\n                  <jats:p>Findings: Burdens indirectly limit disabled people's access to Medicaid home- and community-based services via a complex array of waiver programs that exacerbate costs associated with gaining eligibility. In addition, burdens directly limit access via wait lists and prioritization among the eligible. There is also evidence that states strategically deploy opaqueness to provide political cover for unpopular wait lists. The overall process is opaque, confusing, and time intensive, with burdens falling hardest on marginalized groups.<\/jats:p>\n                  <jats:p>Conclusions: Administrative burdens impede disabled people's efforts to exercise their right to live in the community as afforded to them under the American with Disabilities Act. The opaqueness and associated burdens with waiver programs are a way to conceal these burdens, thereby demonstrating how burdens \u201cneatly carry out the \u2018how\u2019 in the production of inequality, while concealing .\u00a0.\u00a0. the why\u201d (Ray, Herd, and Moynihan 2023: 139).<\/jats:p>","DOI":"10.1215\/03616878-11567708","type":"journal-article","created":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T02:00:50Z","timestamp":1727402450000},"page":"223-251","source":"Crossref","is-referenced-by-count":10,"title":["Rationing Rights: Administrative Burden in Medicaid Long-Term Care Programs"],"prefix":"10.1215","volume":"50","author":[{"given":"Pamela","family":"Herd","sequence":"first","affiliation":[{"name":"University of Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca A.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Georgetown University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"73","published-online":{"date-parts":[[2025,4,1]]},"reference":[{"key":"2025022418525353000_jhppl11567708C1","doi-asserted-by":"crossref","unstructured":"Arbogast\n              Iris\n            \n          , ChorniyAnna, and CurrieJanet. 2022. \u201cAdministrative Burdens and Child Medicaid Enrollments.\u201d National Bureau of Economic Research, Working Paper 30580, October. https:\/\/www.nber.org\/papers\/w30580.","DOI":"10.3386\/w30580"},{"key":"2025022418525353000_jhppl11567708C2","doi-asserted-by":"crossref","DOI":"10.3998\/mpub.10131793","volume-title":"State of Empowerment: Low-Income Families and the New Welfare State","author":"Barnes","year":"2020"},{"issue":"2","key":"2025022418525353000_jhppl11567708C3","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1093\/jopart\/muaa042","article-title":"\u2018It Takes a While to Get Used To\u2019: The Costs of Redeeming Public 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Years on Medicaid Waiver Waitlists.\u201d Spectrum News 13, October31. https:\/\/mynews13.com\/fl\/orlando\/news\/2022\/10\/31\/thousands-of-disabled-floridians-waiting-years-to-get-off-wait-list-for-help."},{"key":"2025022418525353000_jhppl11567708C24","unstructured":"Gunn\n              Erik\n            \n          . 2021. \u201cWaiting Lists End for Family Care, Related Long-Term Care Programs.\u201d Wisconsin Examiner, March11. https:\/\/wisconsinexaminer.com\/2021\/03\/11\/waiting-lists-end-for-family-care-related-long-term-care-programs\/."},{"issue":"1","key":"2025022418525353000_jhppl11567708C25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1352\/1934-9556-54.1.1","article-title":"Disparities in Service Use and Expenditures for People with Intellectual and Developmental Disabilities in California in 2005 and 2013","volume":"54","author":"Harrington","year":"2016","journal-title":"Intellectual and Developmental Disabilities"},{"issue":"suppl. 1","key":"2025022418525353000_jhppl11567708C26","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1111\/1468-0009.12629","article-title":"Improving Older Adults\u2019 Health by Reducing Administrative Burden","volume":"101","author":"Herd","year":"2023","journal-title":"Milbank Quarterly"},{"issue":"suppl. 1","key":"2025022418525353000_jhppl11567708C27","first-page":"S69","article-title":"Shifting Administrative Burden to the State","volume":"73","author":"Herd","year":"2013","journal-title":"Public Administration Review"},{"issue":"4","key":"2025022418525353000_jhppl11567708C28","first-page":"1","article-title":"Introduction: Administrative Burden as a Mechanism of Inequality in Policy Implementation","volume":"9","author":"Herd","year":"2023","journal-title":"Russell Sage Foundation Journal of the Social Sciences"},{"key":"2025022418525353000_jhppl11567708C29","volume-title":"Administrative Burden: Policymaking by Other 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Politics","author":"Michener","year":"2018"},{"key":"2025022418525353000_jhppl11567708C39","unstructured":"MDPHHS (Montana Department of Public Health and Human Services). n.d. \u201cApplication for a \u00a71915(c) Home and Community-Based Services Waiver.\u201d https:\/\/dphhs.mt.gov\/assets\/BHDD\/DDP\/Waivers\/HCBS\/0208DDComprehensiveWaiver062823.pdf (accessed November22, 2024)."},{"key":"2025022418525353000_jhppl11567708C40","article-title":"Medicaid Long-Term Services and Supports Annual Expenditures Report: Federal Fiscal Year 2019","author":"Murray","year":"2021"},{"key":"2025022418525353000_jhppl11567708C41","unstructured":"Ochoa\n              Julio\n            \n          . 2019. \u201cFlorida Faces ADA Lawsuit over Medicaid Waitlist.\u201d WUSF, January22. https:\/\/www.wusf.org\/health-news-florida\/2019\u201301\u201302\/florida-faces-ada-lawsuit-over-medicaid-wait-list."},{"key":"2025022418525353000_jhppl11567708C42","unstructured":"ODDD (Ohio Department of Developmental Disabilities). n.d. \u201cWaiting List Assessment Frequently Asked Questions.\u201d https:\/\/dodd.ohio.gov\/county-boards\/all-county-boards-resources\/waiting-list-assessment-faq (accessed July27, 2023)."},{"key":"2025022418525353000_jhppl11567708C43","unstructured":"PBS NewsHour\n          . 2023. \u201cThe Wait for Government Disability Services Can Last Years.\u201d May15. https:\/\/www.pbs.org\/newshour\/nation\/the-wait-for-government-disability-services-can-last-years-some-states-are-trying-to-change-that#:\u223c:text=Some%20states%20are%20trying%20to%20change%20that,-Nation%20May%2015&text=More%20than%20half%20a%20million,term%20care%20in%20their%20homes."},{"issue":"1","key":"2025022418525353000_jhppl11567708C44","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1093\/jopart\/muac001","article-title":"Racialized Burdens","volume":"33","author":"Ray","year":"2023","journal-title":"Journal of Public Administration Research and Theory"},{"issue":"4","key":"2025022418525353000_jhppl11567708C45","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1215\/03616878-3620833","article-title":"Using the Courts to Shape Medicaid Policy","volume":"41","author":"Rosenbaum","year":"2016","journal-title":"Journal of Health Politics, Policy and Law"},{"key":"2025022418525353000_jhppl11567708C46","unstructured":"Ryan\n              Jennifer\n            \n          , and EdwardsB. Coulter. 2015. \u201cRebalancing Medicaid Long-Term Services and Supports.\u201d Health Affairs, September17. https:\/\/www.healthaffairs.org\/content\/briefs\/rebalancing-medicaid-long-term-services-and-supports."},{"issue":"8","key":"2025022418525353000_jhppl11567708C47","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1377\/hlthaff.2022.00149","article-title":"Trends in Medicaid Home and Community-Based Services Waivers for Older Adults","volume":"41","author":"Skira","year":"2022","journal-title":"Health Affairs"},{"key":"2025022418525353000_jhppl11567708C48","unstructured":"Smink\n              Sam\n            \n          . 2023. \u201cConnecticut's Autism Waiver Program Has a Waitlist of More than 10 Years.\u201d WFSB Channel 3, March8. https:\/\/www.wfsb.com\/2023\/03\/09\/cts-autism-waiver-program-has-waitlist-more-than-10-years-advocates-ask-lawmakers-help\/."},{"key":"2025022418525353000_jhppl11567708C49","article-title":"She's Desperate to Get Home Care for Her Mom. 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L.C.","volume":"17","author":"Williams","year":"2000","journal-title":"Journal of Contemporary Health Law and Policy"},{"issue":"1","key":"2025022418525353000_jhppl11567708C56","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1177\/00031224221147899","article-title":"Hierarchies in the Decentralized Welfare State","volume":"88","author":"Zhang","year":"2023","journal-title":"American Sociological Review"}],"container-title":["Journal of Health Politics, Policy and Law"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/read.dukeupress.edu\/jhppl\/article-pdf\/50\/2\/223\/2221891\/223herd.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/read.dukeupress.edu\/jhppl\/article-pdf\/50\/2\/223\/2221891\/223herd.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,24]],"date-time":"2025-02-24T13:53:44Z","timestamp":1740405224000},"score":1,"resource":{"primary":{"URL":"https:\/\/read.dukeupress.edu\/jhppl\/article\/50\/2\/223\/391180\/Rationing-Rights-Administrative-Burden-in-Medicaid"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,1]]},"references-count":56,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,4,1]]},"published-print":{"date-parts":[[2025,4,1]]}},"URL":"https:\/\/doi.org\/10.1215\/03616878-11567708","relation":{},"ISSN":["0361-6878","1527-1927"],"issn-type":[{"value":"0361-6878","type":"print"},{"value":"1527-1927","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,4]]},"published":{"date-parts":[[2025,4,1]]}}}