Medicaid Home and Community-Based Services Initiation and Acute Services Use

Area of Science:

• Health Services Research
• Gerontology
• Public Health Policy

Background:

• Medicaid is the primary funder of long-term services and supports (LTSS) through home and community-based services (HCBS).
• The impact of Medicaid HCBS on Medicare-covered medical services utilization among dual-eligible beneficiaries remains unclear.
• Understanding this relationship is crucial for optimizing care for vulnerable older populations.

Purpose of the Study:

• To investigate the association between the initiation of Medicaid home and community-based services (HCBS) and subsequent changes in acute care utilization.
• To examine the relationship between Medicaid HCBS initiation and medication prescription patterns.
• To inform policy decisions regarding the integration of HCBS within the broader healthcare system.

Main Methods:

• A cohort study utilized linked Medicare and Medicaid claims data from the Southern Community Cohort Study.
• The study included older adults in 11 southeastern states with continuous Medicare enrollment around their first month of Medicaid HCBS initiation (2006-2018).
• Linear regressions with an event study structure analyzed changes in emergency department use, inpatient discharges, and unique prescription drugs filled in the 6 months before and after HCBS initiation.

Main Results:

• Initiation of Medicaid HCBS was associated with a significant decrease in the probability of emergency department (ED) use (2.70 percentage points) and inpatient discharge (2.63 percentage points).
• These reductions represent a 24% decrease in ED use and a 32% decrease in inpatient discharges compared to pre-HCBS levels.
• While acute service use decreased, the number of unique prescription drugs filled showed a steady increase without a discontinuity at HCBS initiation.

Conclusions:

• Medicaid HCBS initiation is linked to a sustained reduction in acute healthcare services utilization among low-income older adults in the southeastern US.
• The findings suggest that HCBS can effectively mitigate the need for costly acute care services.
• Further research is recommended to explore additional outcomes and inform policies that enhance HCBS effectiveness and clarify its trade-offs with acute care.