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I. INTRODUCTION
Mary Jane Scanlon, a seventy-year old California woman who had been disabled much her of life, needed a live-in caregiver to continue living at home.2 Unaware of the proper channels to find a qualified home caregiver, Mary Jane hired Diane Warrick through an ad posted on Craigslist.3 Unfortunately, Mary Jane was oblivious to Diane's disturbingly extensive criminal and mental history.4 In 1997, Diane tried to take a drug counselor hostage at Napa State Hospital in California,5 shooting at sheriff's deputies during the incident.6 Warrick was convicted of four counts of attempted murder of a peace officer, but was found not guilty by reason of insanity and committed to Patton State Hospital.7 By 2002, a judge found that Warrick had "regained her sanity," and authorities released her to an outpatient program in Contra Costa County.8 Nine years later, a Contra Costa County jury found Diane Warrick guilty of second-degree murder in the stabbing of Mary Jane Scanlon in her home.9 At trial, Warrick testified that she had hallucinated when she stabbed Mary Jane, believing her abusive father was attacking her at the time.10
The tragic death of Mary Jane Scanlon reveals a disturbing problem in obtaining contemporary long-term care: with a swelling senior citizen population,11 skyrocketing costs of institutional care,12 and a strong consumer preference for home and community-based services (HCBS),13 Americans lack access to reliable home care services at a reasonable cost. So long as Medicaid continues to provide these services exclusively through optional state waiver and demonstration programs,14 this problem will persist.15
Medicaid is the primary payer for long-term services and supports (LTSS).16 While Medicaid allows for states to choose whether or not they want to offer home care services,17 it mandates that each state provide nursing facility services to their elderly population.18 This has led to a well-known institutional bias that steers those with long-term care needs into nursing homes regardless of whether or not the individual would prefer to receive care at home.19 With institutional care receiving most of the Medicaid funding and states varying greatly in the types of home care services they choose to offer,20 home care options for the elderly nationwide can be described as inconsistent at best.21
On March 23, 2010, President Barack Obama signed...