Academic journal article Care Management Journals

Beneficiary Profiles and Service Consumption Patterns in an Urban Medicaid Home and Community-Based Waiver Program

Academic journal article Care Management Journals

Beneficiary Profiles and Service Consumption Patterns in an Urban Medicaid Home and Community-Based Waiver Program

Article excerpt

The research reported here was conducted as part of a larger program evaluation of an urban Medicaid Home and Community Based-Waiver Program (HCBS). Informed by a secondary analysis of data collected on 723 clients, this article describes the association between client demographics and service consumption patterns among program beneficiaries with emphasis on access to care issues. The majority of the clients were female, African American, nearly 80 years of age, receiving approximately $600 of monthly income. Although White clients on average were higher functioning, they were hospitalized more frequently and took more medications than African American or Hispanic clients. Clients who were bedbound, Hispanic, and most dependent in performing activities of daily living received the fewest "number of services." Clients who suffered the most severe intellectual impairment, living with a spouse, and with the highest incomes received the most "units of service." Interestingly, service usage did not always increase as the client became more dependent in Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (lADLs), and mobility. The significance of findings is considered in relation to access to care issues.

The Medicaid Home and Community-Based Waiver Program (HCBS) was established in 1981 by the Omnibus Budget Reconciliation Act. HCBS allows states to use Medicaid funds to provide non-institutional, long-term care services to eligible clients. The main purpose of HCBS is to prevent or postpone institutionalization by serving persons with significant, long-term care needs in the community (O'Keefe, 1996). Clients must satisfy certain criteria to be eligible, including financial, categorical, and service criteria.

One of the critical factors necessary for designing and expanding HCBS is access to information regarding service use patterns and client profiles (Han, Barrilleaux, & Quadagno, 1996). Existing research does not provide in-depth information regarding the relationship between client attributes such as age, gender, or living arrangements and the use of HCBS (Han, Barrilleaux, & Quadagno, 1996; Wallace, Levy-Storms, & Andersen, 1997; Weissert, Cready, & Pawelak, 1988). Key to this issue is whether or not some rational measure of need is determining service use or if other factors are affecting receipt of services (Aday, Andersen, & Fleming, 1980; Andersen & Newman, 1973; Han, Barrileaux, & Quadagno, 1996).

This article presents an analysis of one particular HCBS that serves mainly older adult clients. Findings are presented that focus on highlighting the association between user profiles and their service consumption patterns. Policy and program implications of the findings are discussed in relation to access concerns and the distribution of services where need is the major determinant in the allocation of resources (Aday, Andersen, & Fleming, 1980).


Research has demonstrated that certain patient characteristics are related to increased home health care usage (Blewett, Kane, & Finch, 1995; Kane et al., 1994; Kane et al., 1996; Liu, Wissoker, & Rimes, 1998; Solomon et al., 1993; Steiner & Neu, 1993). Patients who are older, female, have greater functional disabilities, and have less available informal supports tend to be heavier users of post-acute care, including skilled nursing facility and home health care. Furthermore, people who are married, non-White, and have supplemental insurance are more likely to use home health care as compared to skilled nursing facility care (Liu, Wissoker, & Rimes, 1998). Mauser and Miller (1994) andTorrez, Estes, and Linkens (1998) found the typical home care patient to be White, female, and 75 years or older. Torrez, Estes, and Linkens (1998) also found a positive relationship between the number of Activities of Daily Living (ADLs) for which the patient needs assistance and number of different types of services received, number of visits certified, and number of visits received. …

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