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This study determined how low-income, disabled, elderly participants in Connecticut managed their long-term care needs after they left or were involuntarily excluded from the state’s Medicaid home and community-based waiver program. This study examined differences between participants and non-participants in their personal, health and functional characteristics, and in their sources of paid and informal care. It also identified reasons why people do not enroll.
Getting By In the Community: Lessons from Frail Elders. Using administrative data from the HCBC program and from Medicare, along with survey data collected from applicants to the HCBC program, the study sought to determine how functionally impaired, elderly persons are able to remain in the community without HCBC program services. It found that the HCBC non-participants are very similar to the HCBC participants along many health, disability, and socioeconomic dimensions. However there are three key areas of difference. First, the non-participants appeared to be somewhat more disabled than the participants, with greater cognitive difficulties (including Alzheimer’s disease) and more functional limitations. Second, the non-participants were much more likely that the participants to be married and to live with others, suggesting greater access to informal caregivers. Finally, as would be expected, non-participants had somewhat greater incomes than the participants did. However, more than half of the non-participants had monthly incomes of less than $1000 (approximately equal to the federal poverty threshold for a couple).
The study looked at how participants and non-participants fared six months after applying for the HCBC program. Given their greater levels of disability and lack of HCBC services, it is perhaps not surprising that non-participants were twice as likely to have entered a nursing home than the participants (12 percent vs. 6 percent). Although many members of both groups relied on Medicare home health (40 percent), interviews with a small sample of non-participants found that informal care and Medicare-funded home care played important roles in allowing them to remain in the community without HCBC program benefits, although more than half reported that they were going without services that they felt they needed.
The higher level of nursing home entry among the non-participants raises questions as to whether the elements of the HCBC program that discourage participation among this non-participant population may save Medicaid dollars in the short-run at the expense of Medicare expenses and future Medicaid costs from more rapid SNF entry.
Impact of the BBA-mandated Interim Payment System on Medicare Home Health Utilization. Although studies have found that implementation of the Interim Payment System (IPS) for home health agencies (HHAs) in 1998 resulted in a 50% decline in Medicare spending for HHAs one year later, little is know about its impact on subgroups of Medicare beneficiaries (those differing by socio-economic and health characteristics). This study used new data from multiple years of the Medicare Current Beneficiary Survey to examine effects of the shift to IPS on these subgroups. It found that access to some HHA care did not change for most subgroups studied. However, home health users who did not have a hospital stay during the year were less likely to have used HHA services. In addition, there were greater declines in the number of visits per user for those subgroups that had had relatively more visits before the IPS went into effect.
Publications
Liu, K., Long, S.K., and Kapustka, H. 2001.
“Interactions Between Medicare and Medicaid Home Care in Connecticut: Responses to the 1997 BBA.”
Home Health Care Services Quarterly, 20(3):75-88.
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