Pass 1 tried to test H5.1 using Texas and found the state's institutional-vs-HCBS spending mix undeterminable — Texas is excluded from both CMS's Mathematica rebalancing report and AARP's LTSS State Scorecard's spending-balance indicator for data-accuracy reasons (see phase0-findings.md §5). This pass picks a second state chosen specifically for data availability, not for a favorable result.
H5.1 — CONSISTENT WITH H5.1 in Indiana (n=1, correlational, confounded)
Corrected on red-team review (red-team-log #11): this section originally headlined "SUPPORTED," which overstated the caveats already disclosed in the body below (n=1, correlational, and confounded by Indiana's own 2024 waiver restructuring). The evidence is consistent with H5.1, not a confirmation of it.
Indiana was chosen because it has both a well-documented, fast-growing aged/disabled waiver waitlist and genuine spending-mix data — unlike Texas, it isn't excluded from the relevant national trackers.
- Waitlist: Indiana split its Aged & Disabled Waiver in July 2024 into PathWays (60+) and Health & Wellness (under 60, disabled); both hit approved capacity almost immediately. Combined waitlist ≈12,800 (July 2024) growing to over 17,000 by February 2026 — nineteen months, not the "eighteen months" the whitepaper printed (corrected on Phase 1 verification, 2026-08-10) — worsening, not stabilizing, and confirmed independently by the state agency (FSSA/DDARS), KFF's national survey, and state-level journalism.
- Spending mix: two independent-ish figures both put Indiana well below the ~53% national HCBS share for the aged/physical-disability population (AARP, FY2020): the state's own current legislative HCBS report says 34% HCBS / 66% institutional, "well behind the national average" in the report's own words; AARP's 2023 Scorecard (FY2020) puts it closer to 23% HCBS / 77% institutional (lower-confidence, single-source, could not re-verify against AARP's primary page directly). Top HCBS-heavy states reach 83.2%.
- Verdict: nothing in the record suggests Indiana is a low overall LTSS spender — the pattern is a large, fast-growing waitlist sitting on top of a spending mix that sends roughly two-thirds to three-quarters of Medicaid LTSS dollars to institutional care. This is a clean directional match for H5.1's "architecture, not money" framing, in exactly the state Texas's data gap prevented testing.
Caveat, stated plainly: this is one state, correlational, not causal — it shows the pattern is consistent with H5.1, not that architecture causes the waitlist independent of other factors (e.g., Indiana's 2024 waiver restructuring itself may be a confounder, since both new waivers hit capacity almost immediately after launch). A stronger test would need more states with both good data and a similar test, or a within-state before/after design around a spending-mix policy change.
Combined picture across the two states tested so far
Texas (pass 1) and Indiana (pass 2) together illustrate the same meta-finding from a different angle: the states most useful for testing H5.1 tend to be exactly the ones with poor spending-mix data (Texas), while the ones with good data (Indiana) confirm the hypothesis. Whether that's coincidence or a real pattern (e.g., institutionally-biased states also under-invest in LTSS spending transparency) is worth a note in the whitepaper but is speculation at this point, not a finding — flagged as such rather than asserted.
Sources
KFF, "A Look at Waiting Lists for Medicaid HCBS from 2016 to 2025"; AARP 2023 LTSS State Scorecard, "Medicaid LTSS Balance: Spending" indicator; Indiana Capital Chronicle (Feb 2026); WFYI (Feb 2026); Indiana FSSA/DDARS waiver waitlist releases.
Confidence tier
Medium. Waitlist trend/scale: strongly corroborated across agency, national-survey, and journalism sources at multiple time points. Spending-split percentage: directional/order-of-magnitude confidence only — the two cited figures (34% vs. ~23%) disagree with each other, and one could not be re-verified against its primary source.