Comparing Outcomes Among Medicaid Home and Community-Based Service Users: Private Homes vs. Assisted Living...

Area of Science:

• Health Services Research
• Gerontology
• Public Health Policy

Background:

• Home and community-based services (HCBS) are crucial for aging populations.
• Understanding outcomes based on HCBS setting is vital for care planning.
• Dually eligible individuals (Medicare and Medicaid) represent a significant user group.

Purpose of the Study:

• To compare health outcomes for dually eligible individuals aged 65+ using Medicaid HCBS in private homes versus assisted living facilities.
• To identify differences in hospitalizations, emergency department visits, days at home, and healthcare spending between HCBS settings.

Main Methods:

• Utilized an instrumental variable (IV) approach to mitigate confounding factors.
• Analyzed linked Medicare and Medicaid claims data from 2016-2019.
• Included over 383,000 individuals across 883 counties in 39 states.

Main Results:

• In-home HCBS users experienced higher monthly hospitalization rates (1.3 pp increase) and fewer days at home (-0.3 days) compared to assisted living residents.
• Further analysis indicated increased likelihoods of hospitalizations, emergency department visits, and higher Medicaid spending for in-home HCBS users.
• The majority of HCBS users (85%) resided in private homes.

Conclusions:

• In-home HCBS users face a higher risk of adverse health events compared to those in assisted living facilities.
• Findings suggest a need for enhanced support and improved care delivery for individuals receiving HCBS at home.
• Policymakers should consider interventions to address disparities in outcomes between different HCBS settings.