Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program Appendices

APPENDICES: APPENDIX A: Sample Selection Procedures; APPENDIX B: Recipient and Other Predictor Variables, Detailed Tables; APPENDIX C: Testing Factors Associated with Provider Selection; APPENDIX D: Hierarchical Condition Classification and Distribution for IHSS Recipients by Age and Provider Relationship; APPENDIX E: Physician, Outpatient Department, and Emergency Room Use and Expenditures; APPENDIX F: Home Care and Nursing Home Expenditures and Use

NOTES

LIST OF TABLES: TABLE B-1: Race/Ethnicity of IHSS Recipients, 2005; TABLE B-2: Functional Limitations of IHSS Recipients, 2005; TABLE B-3: Vendor Claims Counts Fee for Service and Managed Care Recipients, 2005; TABLE B-4: County Per Capita Income, 2005; TABLE C-1: Predicting Provider Relationships, IHSS Recipients Age 3-17, 2005; TABLE C-2: Predicting Provider Relationships, IHSS Recipients Age 18-64, 2005; TABLE C-3: Predicting Provider Relationships, IHSS Recipients Age 65+, 2005; TABLE D-1: Hierarchical Condition Classification Distribution for IHSS Recipients Age 3-17 by Provider Relationship, 2005; TABLE D-2: Hierarchical Condition Classification Distribution for IHSS Recipients Age 18-64 by Provider Relationship, 2005; TABLE D-3: Hierarchical Condition Classification Distribution for IHSS Recipients Age 65+ by Provider Relationship, 2005; TABLE D-4: Ambulatory Care Sensitive Conditions by Provider Relationship, Recipients Age 3-17, 2005; TABLE D-5: Ambulatory Care Sensitive Conditions by Provider Relationship, Recipients Age 18+, 2005; TABLE E-1: Adjusted Medicaid-Paid Medical Care Use, Excluding Emergency Room Use, by IHSS Recipients, 2005; TABLE E-2: Mean Medicaid-Paid Physician Expenditures by IHSS Recipients, 2005; TABLE E-3: Mean Medicaid-Paid Outpatient Department Expenditures by IHSS Recipients, 2005; TABLE F-1: Unadjusted Probability of Medicaid-Paid Nursing Home Stays by IHSS Recipients, 2005; TABLE F-2: Adjusted Medicaid-Paid Nursing Home Use by Adult IHSS Recipients, 2005; TABLE F-3: Adjusted Mean Medicaid-Paid Monthly HCBS Waiver Expenditures by IHSS Recipients, 2005; TABLE F-4: Logarithm Transformed Mean Monthly Medicaid-Paid IHSS Expenditures by IHSS Recipients, 2005; TABLE F-5: Logarithm Transformed Mean Monthly Medicaid-Paid Nursing Home Expenditures by IHSS Recipients, 2005

Main Report: http://aspe.hhs.gov/daltcp/reports/2008/IHSSPlus.htm

Appendices: http://aspe.hhs.gov/daltcp/reports/2008/IHSSPlus2.htm

APPENDIX A. SAMPLE SELECTION PROCEDURES

The study sample was selected from In-Home Supportive Services (IHSS) recipient listings in 2005. It included anyone in the program as of January 1 of that year, or who entered the IHSS program sometime during 2005. This full sample of recipients is used in analyses describing program recipient characteristics and in analysis of the factors associated with provider selection. Analysis that consider health care use, Medicaid expenditures, or that include health conditions were limited to a subset of IHSS recipients: persons receiving Medicaid through fee for service reimbursement. The exclusion of Medicaid managed care program recipients was necessary because Medicaid claims are not submitted for managed care covered services. The following outlines the steps used to select, screen, and qualify IHSS recipients into the study sample. In combination these assure that we obtained all waiver recipients in each of the target age categories as well as recipients in Advance Pay, and Restaurant Meals vouchers:

All recipients identified as being an active IHSS recipient during any month in calendar year 2005 were tentatively selected into the study (n=408,276).¹ Data for both 2004 and 2005 was compiled for these individuals.
The tentatively eligible IHSS recipients included 4,350 pairs of recipients with the same Social Security number, but different IHSS identification numbers. This can occur as recipients are given a new IHSS number if they move from one county to another, even while being an IHSS recipient. There is also the possibility of typographical errors in the identification numbers recorded in the data files. To determine if cases with the same Social Security number were the same individuals, we compared the records on date of birth and whether they had no more than one overlapping month of claims data. Cases meeting these criteria were retained, consolidating the pair under a single common IHSS number. Of the pairs with consistent birthdates, 3,486 had no overlapping claims months, 346 had one overlapping claim month, 301 had more than one overlapping claims month. The remaining 217 pairs had different birth dates. These latter 518 cases were dropped from the study sample.
An additional 42 IHSS recipients had duplicate Department of Developmental Services (DDS) identification numbers that could not be resolved. These cases were also dropped from the IHSS sample.
Within the age group 3-17 any recipient with a Spouse provider (one person in 2005) was excluded because there were too few cases for subgroup analysis. Among those 65 or older, those with “Parent” providers (n=2) were similarly excluded.
The final eligible IHSS sample was sorted into three subgroups: those age 3-17, those age 18-64, those age 65 or more. Individuals changing age group during the calendar year were retained in the original age group.
Advance Pay and Restaurant Meals voucher program recipients were identified using the IHSS Services Assessment. This indicates recipients requesting who are eligible for the program. Such recipients were selected, and the number of participation months was compiled.
IHSS recipients are eligible for Medicaid, but the number of Medicaid claims-records can be under reported for individuals enrolled in a managed care plan. Being in managed care affects the availability and reliability of Medicaid claims data. Managed care organizations are reimbursed on a capitated basis for members, rather than on the basis of utilization. As a consequence services such as hospital, physician, and outpatient services (services included under the capitation payment) may not generate a Medicaid claim. Services (e.g., community-based care, IHSS, and extended nursing home stays) not included under the capitation are not affected. In 2005, 56,1522 (13.9%) study recipients were managed care members for all or part of the year, another. All such cases were list-wise excluded from analyses using Medicaid claims for diagnoses and health care use/expenditures.
IHSS recipients participating in DDS programs were identified by linking the IHSS study sample records with DDS assessment files. This match was limited to persons having Medicaid eligibility.
Classification of waiver and non-waiver recipients was based on the provider relationship information available in the IHSS provider eligibility files. Among those age less that 18, waiver/Residual Program participants are those with a Parent provider. For those 18-64 and 65 or more waiver/Residual Program participants are those with a paid Spouse provider. (Parents of those age 65 or more would also be eligible, but these cases were excluded from the analysis.)²

APPENDIX B. RECIPIENT AND OTHER PREDICTOR VARIABLES, DETAILED TABLES

TABLE B-1: Race/Ethnicity of IHSS Recipients, 2005
	Age of IHSS Recipients
	3-17		18-64		65+		Total
	n	%	n	%	n	%	n	%
All Recipients 2005	16,257	100.0	152,591	100.0	233,856	100.0	402,704	100.0
White	4,580	28.2	65,400	42.9	90,562	38.7	160,542	39.9
Hispanic	7,220	44.4	32,887	21.6	55,327	23.7	95,434	23.7
Black	2,875	17.7	39,260	25.7	25,156	10.8	67,291	16.7
Other Asian or Pacific Islander	182	1.1	1,691	1.1	3,180	1.4	5,053	1.3
Am Indian or Alaskan Native	91	0.6	1,337	0.9	870	0.4	2,298	0.6
Filipino	245	1.5	1,803	1.2	12,734	5.4	14,782	3.7
Chinese	241	1.5	1,995	1.3	23,331	10.0	25,567	6.3
Cambodian	142	0.9	1,456	1.0	2,459	1.1	4,057	1.0
Japanese	12	0.1	141	0.1	329	0.1	482	0.1
Korean	62	0.4	590	0.4	4,334	1.9	4,986	1.2
Samoan	25	0.2	291	0.2	319	0.1	635	0.2
Asian Indian	84	0.5	471	0.3	1,766	0.8	2,321	0.6
Hawaiian	13	0.1	44	0.0	42	0.0	99	0.0
Guamanian	5	0.0	53	0.0	44	0.0	102	0.0
Laotian	132	0.8	2,120	1.4	3,146	1.3	5,398	1.3
Vietnamese	348	2.1	3,052	2.0	10,257	4.4	13,657	3.4
Recipients Continuing from 2004	13505		126118		198523		338146
White	3783	28.0	54032	42.8	78927	39.8	136742	40.4
Hispanic	6087	45.1	27241	21.6	45888	23.1	79216	23.4
Black	2366	17.5	32342	25.6	21961	11.1	56669	16.8
Other Asian or Pacific Islander	143	1.1	1372	1.1	2578	1.3	4093	1.2
Am Indian or Alaskan Native	74	0.5	1075	0.8	721	0.4	1870	0.6
Filipino	196	1.4	1450	1.1	10002	5.0	11648	3.4
Chinese	180	1.3	1652	0.3	19380	9.8	21212	6.3
Cambodian	130	1.0	1219	1.0	2190	1.1	3539	1.0
Japanese	11	0.1	118	0.1	250	0.1	379	0.1
Korean	47	0.03	470	0.4	3474	1.7	3991	1.2
Samoan	20	0.01	218	0.2	258	0.1	496	0.1
Asian Indian	65	0.05	368	0.3	1431	0.7	1864	0.6
Hawaiian	10	0.1	38	0.03	31	0.02	79	0.02
Guamanian	4	0.03	41	0.03	38	0.02	83	0.02
Laotian	112	0.8	1831	0.5	2820	1.4	4763	1.4
Vietnamese	277	2.1	2651	2.1	8574	4.3	11502	3.4
Recipients Entering in 2005	2752		26473		35333		64558
White	797	29.0	11368	42.9	11635	32.9	23800	36.9
Hispanic	1133	41.2	5646	21.3	9439	26.7	16218	25.1
Black	509	18.5	6918	26.1	3195	9.0	10622	16.5
Other Asian or Pacific Islander	39	1.4	319	1.2	602	1.7	960	1.5
Am Indian or Alaskan Native	17	0.6	262	1.0	149	0.4	428	1.7
Filipino	49	1.8	353	1.3	2732	7.7	3134	4.9
Chinese	61	2.2	343	1.3	3951	11.2	4355	6.7
Cambodian	12	0.4	237	0.9	269	0.8	518	0.8
Japanese	1	0.04	23	0.09	79	0.2	103	0.2
Korean	15	0.5	120	0.5	860	2.4	995	1.5
Samoan	5	0.2	73	0.3	61	0.2	139	0.2
Asian Indian	19	0.7	103	0.4	335	0.9	457	0.7
Hawaiian	3	0.1	6	0.02	11	0.03	20	0.03
Guamanian	1	0.04	12	0.04	6	0.02	19	0.03
Laotian	20	0.7	289	1.1	326	0.9	635	1.0
Vietnamese	71	2.6	401	1.5	1683	4.8	2155	3.3

TABLE B-2: Functional Limitations of IHSS Recipients, 2005
	Age of IHSS Recipients
	3-17		18-64		65+		Total
	n	%	n	%	n	%	n	%
Functional Areas	16,257	100.0	152,591	100.0	233,856	100.0	402,704	100.0
Cognitive Limitations^a
0	12,346	75.9	141,114	92.5	227,051	97.1	380,511	94.5
1	914	5.6	2,580	1.7	1,682	0.7	5,176	1.3
2	501	3.1	1,685	1.1	1,022	0.4	3,208	0.8
3	2,496	15.4	7,212	4.7	4,101	1.8	13,809	3.4
ADL Limitations^b
0	545	3.4	23,539	15.4	26,619	11.4	50,703	12.6
1	805	5.0	21,862	14.3	35,331	15.1	57,998	14.4
2	1,732	10.7	29,866	19.6	44,513	19.0	76,111	18.9
3	3,962	24.4	27,676	18.1	41,947	17.9	73,585	18.3
4	4,567	28.1	31,760	20.8	57,932	24.8	94,259	23.4
5	4,646	28.6	17,888	11.7	27,514	11.8	50,048	12.4
IADL Limitations^c
0	2,571	15.8	215	0.1	83	0.0	2,869	0.7
1	1,826	11.2	581	0.4	508	0.2	2,915	0.7
2	678	4.2	1,338	0.9	1,209	0.5	3,225	0.8
3	730	4.5	5,072	3.3	5,676	2.4	11,478	2.9
4	6,716	41.3	89,577	58.7	115,673	49.5	211,966	52.6
5	3,736	23.0	55,808	36.6	110,707	47.3	170,251	42.3
Breathing^d	2,352	14.5	10,623	7.0	14,219	6.1	27,194	6.8
Number of tasks cannot perform memory, orientation, or judgment tasks without human assistance. Number of tasks cannot perform assistance in activities of daily living (i.e., bathing and grooming; dressing; transferring; bowel, bladder and menstrual care; eating) without human assistance. Number of tasks cannot perform instrumental activities of daily living (i.e., housework, laundry, shopping and errands, meal preparation and clean-up, mobility inside) without human assistance. Cannot breathe without human assistance.

TABLE B-3: Vendor Claims Counts Fee for Service and Managed Care Recipients, 2005
Vendor Group Descriptions	Total
Vendor Group Descriptions	# Recipients	%	# MC	%
Community-Based Care
Adult Day Health Care	31,418	7.9%	2,018	3.8%
IHSS (State Plan Personal Care)	366,625	92.5%	48,982	91.3%
Medicaid Home Care Waivers^a	13,638	3.4%	2,100	3.9%
Home Health Agency	7,088	1.8%	398	0.7%
Inpatient Services
Hospital (County & Community hospitals)	100,127	25.3%	4,496	8.4%
Nursing Homes (and ICF-DDs)	18,585	4.7%	776	1.4%
Medical Care/Physician Services
Birthing Services^b	183	0.0%	49	0.1%
Physician Offices/Clinics^c	300,203	75.8%	17,182	32.0%
Outpatient Departments/Clinics^d	193,697	48.9%	6,946	12.9%
Mental Health Services^e	951	0.2%	62	0.1%
Other Providers
Ancillary Providers^f	65,436	16.5%	1,847	3.4%
Physical/Occupational/Speech Therapy^g	10,627	2.7%	1,463	2.7%
Vision/Hearing Services^h	114,187	28.8%	10,201	19.0%
Other Servicesⁱ	79,108	20.0%	5,081	9.5%
Durable Medical Equipment	112,749	28.5%	4,151	7.7%
Medical Transportation	56,244	14.2%	1,685	3.1%
Total	394,987		53,571
Includes AIDS waiver, MSSP, and Home Care waivers. Includes nurse midwife (n=32 FFS and 2 MC clients), and genetic testing (n=153 FFS and 47 MC clients). Includes nurse practitioners, physicians, physician groups, rural clinics, surgi-centers. Includes county and community hospital outpatient departments, and other organized outpatient clinics. Includes psychologist/social worker outpatient services, and inpatient mental health. Includes acupuncturist, chiropractor, podiatrist, prosthetist, breast cancer detection center, EPSDT supplemental services, hemodialysis/renal centers, respirator care practitioner, hospice services, nurse anesthetist. Also includes hospital and freestanding rehabilitation facilities. Includes optical labs, optometric groups, optometrists, optician, audiologist, hearing aid dispenser. Includes clinical labs, portable x-ray lab, blood bank, local health education.

TABLE B-4: County Per Capita Income, 2003
County	Per Capita Income/1000 Population	IHSS Recipients by County	County	Per Capita Income/1000 Population	IHSS Recipients by County
ALAMEDA	38.618	14,508	ORANGE	36.647	13,702
ALPINE	24.946	15	PLACER	35.847	1,498
AMADOR	23.570	214	PLUMAS	26.597	371
BUTTE	22.818	3,389	RIVERSIDE	25.691	14,629
CALAVERAS	23.537	313	SACRAMENTO	29.548	18,342
COLUSA	21.668	226	SAN BENITO	23.484	352
CONTRA COSTA	41.992	7,208	SAN BERNARDINO	22.141	18,801
DEL NORTE	17.676	367	SAN DIEGO	33.883	22,977
EL DORADO	33.477	679	SAN FRANCISCO	55.819	18,468
FRESNO	21.938	12,640	SAN JOAQUIN	23.155	6,784
GLENN	18.031	453	SAN LUIS OBISPO	27.917	1,695
HUMBOLDT	23.909	2,116	SAN MATEO	57.906	2,667
IMPERIAL	18.171	5,117	SANTA BARBARA	33.739	2.824
INYO	26.084	137	SANTA CLARA	51.579	12,395
KERN	21.021	5,647	SANTA CRUZ	36.865	2,005
KINGS	16.717	1,619	SHASTA	25.175	2,932
LAKE	23.538	1,974	SIERRA	24.681	34
LASSEN	18.122	287	SISKIYOU	22.640	553
LOS ANGELES	30.611	167,927	SOLANO	26.830	2,886
MADERA	18.392	1,615	SONOMA	34.671	4,319
MARIN	63.083	1,484	STANISLAUS	22.677	5,701
MARIPOSA	22.903	270	SUTTER	24.075	712
MENDOCINO	25.947	1,549	TEHAMA	19.868	1,263
MERCED	18.461	3,112	TRINITY	21.223	192
MODOC	21.275	163	TULARE	20.166	2,787
MONO	24.241	44	TUOLUMNE	23.515	341
MONTEREY	29.901	3,199	VENTURA	32.232	3,408
NAPA	37.086	690	YOLO	27.332	1,506
NEVADA	31.241	799	YUBA	19.236	829
SOURCE: Table D-9, US Department of Commerce, Bureau of Economic Analysis, http://www.bea.doc.gov

APPENDIX C. TESTING FACTORS ASSOCIATED WITH PROVIDER SELECTION

The analyses presented in this Appendix extend the descriptive findings using logistic regression to adjust for recipient differences within a provider group. Separate analyses are conducted by recipient age group to address the following questions:

Do the functional limitations, task assistance needs, and chronic health conditions of individuals differ between waiver and non-waiver recipients?
Do waiver and non-waiver recipients differ in terms of living arrangement household size, race/ethnicity, and availability of legally responsible relatives?
Adjusting for recipient characteristics and living arrangements, are there differences between new and continuing IHSS recipients in provider selection?

The “outcome” of these models is provider type. The recipient data are from the first available IHSS assessment instrument available prior to the start of the observation period. Most of the models, Table C-1, Table C-2 and Table C-3, include all IHSS recipients in the modeled age group, but there are three exceptions. The models predicting Parent providers among those age 3-17 are limited to minor children with a parent in the household. Similarly, the models predicting Spouse providers among adults are limited to persons with a spouse in the household. The Authorized IHSS Service Hours, while it may reflect unmeasured functional status is not included in these models as this measure is determined in part by living arrangement and provider type.

The coefficient of primary interest in these models is the dummy variable representing recipients entering IHSS in 2005 versus those who were continuing from 2004. Among minor children, those with Parent providers are less likely to be newly entering IHSS recipients in 2005, and those with Non-Relative providers are more likely to be new recipients. Non-aged adults reflect a somewhat similar pattern with those having Parent or Spouse providers being less likely to be new recipients. Correspondingly, new recipients had higher odds of having either Other Relatives and Non-Relative providers. This pattern changes somewhat among those 65+. New IHSS recipients have higher odds than continuing recipients of having a Spouse provider, and slightly lower odds of having a Non-Relative provider. There is no difference between recipient participation status in the odds of having Other Relative providers. These findings suggest that between 2004 and 2005 (the starting year for the IHSS Plus Waiver program) there was no consistent pattern in the enrollment of new recipients shifting them toward waiver covered providers (i.e., parents for minor children recipients, spouses for adult recipients). Among children the opposite occurred, with new recipients being less likely than continuing recipients to be among those with Parent providers. Among non-aged adults there was no difference in the odds of new recipients using Spouse providers. Only among those age 65+ did new recipients have greater odds than continuing recipients of having a Spouse provider.

Turning now to the other policy questions, the coefficients in the models provide indicators of the statistically significant differences within provider type relative to race/ethnicity, functional ability, and living arrangement.

The findings from the tables are briefly summarized here:

Females show no difference from males in predicting providers among children. However among adults, they are less likely to have Parent or Spouse providers. They are also more likely to have Other Relative providers and less likely to have Non-Relatives.
Hispanic recipients across all age strata are substantially more likely than Whites to have Parent or Spouse providers, and less likely to have Non-Relative providers; and among adults to be more likely to have Other Relative providers.
Black recipients across children and non-aged adults are less likely than Whites to have Parent providers, more likely to have Other Relative providers, and less likely to have Non-Relative providers. Among the aged they are more likely to have a Spouse provider and somewhat less likely to have Other Relative providers.
Asian and the other minority children recipients are more likely than Whites to use Parent and Other Relative providers, and less likely to use Non-Relatives. Among adults they are more likely than Whites to use Spouse and Other Relative providers and less likely to use Parents and Non-Relatives.
The odds of having a paid Parent provider increase substantially among minor children who require task assistance from another individual in three or more ADLs, or in three cognitive tasks, or with breathing problems. These same factors reduce the odds of having other providers (with no difference between Relative and Non-Relative providers). Among adult recipients these higher levels of limitations are generally associated with increased odds of Parent and Spouse providers (when they are available). Correspondingly these frailty measures are generally associated with reduced odds of having either Other Relative or Non-Relative providers.
Managed care membership is in the models to assess the extent to which enrollment in these Medicaid plans might be biased relative to the various provider types. Among minor children there was generally no significant difference in membership among those with each type of provider. The exception was a marginally significant difference with those having Non-Relative providers being less likely to be in managed care. For recipients age 18-64, managed care members were more likely among those with Parent and Spouse providers, and less likely among those with Other Relative and Non-Relative providers. For recipients age 65+, managed care members were more likely among Spouse and Other Relative providers, and less likely among Non-Relatives. Managed care differences may contribute to an under count of chronic health conditions and health service use among those provider types having higher likelihood of enrollment in such plans.
Household size, adjusting for race, has no association with the odds of Parent providers for children, but larger households are more likely to have Other Relative and less likely to have Non-Relative providers. Among those 18-64 size is positively related to having a Parent or Other Relative provider, and negatively related to having Non-Relative providers. Recipients age 65 or more in larger households are less likely to have Spouse and Non-Relative providers, and more likely to have Other Relatives.
Regardless of recipient age, the presence of a parent or spouse in the household reduces the odds of having non-relatives as paid IHSS providers. Among those 18-64 a present spouse has a modest association with having Other Relative providers.
Among minor children the comparison of recipients in counties with IHSS wage levels relative to the average rate in the state (i.e., Los Angeles and Fresno Counties) showed few statistically significant relationships. In counties with hourly wages of $10 or more, the likelihood of a Parent being a paid provider reduced relative to recipients in Los Angeles. No differences were found for the other provider groups. Recipients age 18-64 offer a somewhat similar pattern. Parents in counties with IHSS wages above $9 per hour were less likely to be paid providers, and there was a modest tendency for non-relatives to assume the provider role. The choice of Spouse provider was positive across all wage rate levels, suggesting differences between Los Angeles and Fresno and the other counties in the state that may not necessarily be related to wage rates. Among aged recipients, the prior pattern for Spouse providers holds, accept in the highest wage rate counties, which do not differ from Los Angeles and Fresno. Across all but the highest wage rates, counties show a tendency toward more Other Relative providers and somewhat less likelihood of Non-Relative providers than Los Angeles and Fresno.³
County per capita, in the models as an adjustment for cost of living, has an association with provider type, but with a weight near 1.0 across all recipient ages and provider types. These effects reflect the change in likelihood of a provider with each $1,000 increment in county per capita income. There is a modest positive association with Non-Relative providers among all age groups, and no statistically significant association with Spouse providers among adult recipients. Among minor children recipients, higher per capita income is associated with a reduced likelihood of a Parent provider. Among those age 18-64, there is a positive association with per capita income and Parent providers, and for all adult recipients a lower likelihood of Other Relative providers.

TABLE C-1: Predicting Provider Relationships, IHSS Recipients Age 3-17, 2005
Total Recipients n=16257	Provider Relationship
Total Recipients n=16257	Parent^g n=11056		Other Relative n=2090		Non-Relative n=2589
Predictors	Odds Ratio	95% CI	Odds Ratio	95% CI	Odds Ratio	95% CI
Intercept
Recipient Characteristics^a
Female Recipient	1.04	0.96-1.12	0.95	0.86-1.05	0.99	0.91-1.08
Hispanic	1.94	1.75-2.14	0.79	0.70-0.90	0.44	0.40-0.50
Black	0.80	0.71-0.90	1.63	1.42-1.88	0.87	0.77-0.98
Asian/Other	1.28	1.10-1.48	1.21	1.01-1.43	0.57	0.49-0.67
3+ Cognitive Limitations^b	1.22	1.11-1.35	0.83	0.73-0.93	0.86	0.77-0.95
3+ ADL Limitations^c	1.17	1.06-1.30	0.88	0.78-0.99	0.85	0.77-0.95
Respiratory Limitations^d	1.15	1.03-1.29	0.99	0.86-1.14	0.80	0.70-0.91
Managed Care Member	1.08	0.98-1.18	0.93	0.83-1.04	0.90	0.81-0.99
Living Arrangement
Parent Present (n=14623)	na	na	0.19	0.17-0.21	0.47	0.42-0.53
Household size (1-5)^e	0.98	0.94-1.02	1.10	1.05-1.15	0.93	0.89-0.97
County Measures
IHSS Wage Rate^f
<$7.50 per hour	1.08	0.96-1.23	0.74	0.63-0.87	1.02	0.89-1.16
$8 per hour	1.30	1.17-1.45	0.92	0.81-1.05	0.69	0.61-0.79
$9.50-$9.75 per hour	0.88	0.78-1.01	1.00	0.85-1.18	1.07	0.92-1.23
>$10 per hour	0.64	0.49-0.83	1.11	0.81-1.52	0.93	0.71-1.23
Per Capita Income (000’s)	0.97	0.97-0.98	1.01	1.00-1.02	1.03	1.02-1.04
New IHSS Recipient	0.69	0.63-0.76	1.03	0.91-1.07	1.43	1.28-1.59
Model Goodness of Fit
-2Log Likelihood	15536.5		11471.0		13493.0
Maximum Rescaled R²	0.071		0.112		0.078
SOURCE: California Department of Social Services, unpublished CMIPS data for 2005. Reference is White. Race/ethnicity Asian/Other includes in descending order by number in this age group, Vietnamese, Filipino, Chinese, Cambodian, Laotian, American Indian or Alaskan Native, Asian Indian, Korean, Samoan, Hawaiian, Japanese, and all others. Cognition is defined by: memory, orientation, and judgment. Each scored 1 independent; 2 able to perform, but needs verbal assistance such as reminders, guidance, or encouragement; 5 cannot perform without human assistance. Scores three and four not used. The measure is a dummy variable yes = have three cognitive measures each with a score five. ADLs refers to activities of daily living (i.e., bathing and grooming; dressing; transferring; bowel, bladder and menstrual; eating). Each task is scored on a four or five point scale: 1 and 2 as per above, 3 Can perform with some human direct physical assistance from the provider, 4 Can perform with a lot of human assistance, 5 cannot perform without human assistance. The measure is a dummy variable yes = have three or more ADLs each with a score of three or more indicating the need for human assistance. Breathing is scored 1 independent, 5 cannot perform without human assistance, 6 paramedical services needed. The measure is the presence/absence of a breathing item with a score of five or more. Number of persons in household, including other IHSS recipients, excludes recipients non-IHSS children <age 14. The omitted category for IHSS wages is $7.50/hr (reflective of Los Angeles and Fresno Counties residence for about 44% of IHSS recipients. The model includes only recipients who have a parent present, n shown in the column heading is the number of Parent providers, n shown in the Parent Present row is the number of parents available in the sample. “na” is not applicable.

TABLE C-2: Predicting Provider Relationships, IHSS Recipients Age 18-64, 2005
Total Recipients n=152,591	Provider Relationship
Total Recipients n=152,591	Parent n=23,492		Spouse^g n=8,132		Other Relative n=49,407		Non-Relative n=70,974
Predictors	Odds Ratio	95% CI	Odds Ratio	95% CI	Odds Ratio	95% CI	Odds Ratio	95% CI
Intercept
Recipient Characteristics^a
Female Recipient	0.50	0.48-0.51	0.31	0.29-0.33	2.04	1.99-2.09	0.90	0.88-0.92
Hispanic	1.42	1.37-1.48	2.51	2.33-2.71	1.16	1.12-1.19	0.56	0.55-0.58
Black	0.56	0.53-0.58	1.54	1.38-1.72	1.32	1.28-1.36	0.90	0.88-0.93
Asian/Other	0.86	0.81-0.91	1.57	1.44-1.72	1.79	1.72-1.86	0.51	0.49-0.53
3+ Cognitive Limitations^b	4.10	3.92-4.28	2.21	1.84-2.67	0.54	0.51-0.57	0.45	0.43-0.48
3+ ADL Limitations^c	1.53	1.48-1.58	5.27	4.90-5.68	0.75	0.74-0.77	0.85	0.83-0.87
Respiratory Limitations^d	0.97	0.91-1.03	1.29	1.16-1.44	0.91	0.87-0.95	1.05	1.01-1.10
Managed Care Member	1.22	1.17-1.27	1.41	1.31-1.53	0.89	0.87-0.92	0.94	0.91-0.97
Living Arrangement
Spouse Present (n=25,516)	0.03	0.02-0.03	na	na	1.55	1.51-1.60	0.40	0.39-0.41
Household size (1-5)^e	1.53	1.51-1.54	0.99	0.97-1.02	1.24	1.23-1.25	0.65	0.64-0.65
County Measures
IHSS Wage Rate^f
<$7.50 per hour	1.10	1.04-1.15	2.07	1.90-2.26	0.61	0.59-0.63	1.27	1.23-1.31
$8 per hour	1.39	1.33-1.45	2.06	1.89-2.26	0.80	0.77-0.82	0.89	0.86-0.92
$9.50-$9.75 per hour	0.93	0.88-0.98	1.29	1.17-1.43	0.94	0.91-0.97	1.04	1.00-1.07
>$10 per hour	0.78	0.70-0.87	1.59	1.28-1.98	0.90	0.83-0.97	1.19	1.10-1.28
Per Capita Income (000’s)	1.01	1.01-1.01	1.00	0.99-1.01	0.98	0.98-0.98	1.01	1.01-1.02
New IHSS Recipient	0.57	0.55-0.60	0.95	0.88-1.03	1.14	1.11-1.18	1.11	1.08-1.14
Model Goodness of Fit
-2Log Likelihood	103,330.5		25,616.7		181,058.3		185,067.1
Maximum Rescaled R²	0.288		0.307		0.098		0.207
SOURCE: California Department of Social Services, unpublished CMIPS data for 2005. Reference is White. Race/ethnicity Asian/Other includes in descending order by number in this age group, Vietnamese, Laotian, Chinese, Filipino, Cambodian, American Indian or Alaskan Native, Korean, Asian Indian, Samoan, Japanese, and others. Cognition is defined by: memory, orientation, and judgment. Each scored 1 independent; 2 able to perform, but needs verbal assistance such as reminders, guidance, or encouragement; 5 cannot perform without human assistance. Scores three and four not used. The measure is a dummy variable yes = have three cognitive measures each with a score five. ADLs refers to activities of daily living (i.e., bathing and grooming; dressing; transferring; bowel, bladder and menstrual; eating). Each task is scored on a four or five point scale: 1 and 2 as per above, 3 Can perform with some human direct physical assistance from the provider, 4 Can perform with a lot of human assistance, 5 cannot perform without human assistance. The measure is a dummy variable yes = have three or more ADLs each with a score of three or more indicating the need for human assistance. Breathing is scored 1 independent, 5 cannot perform without human assistance, 6 paramedical services needed. The measure is the presence/absence of a breathing item with a score of five or more. Number of persons in household, including other IHSS recipients, excludes recipients non-IHSS children <age 14. The omitted category for IHSS wages is $7.50/hr (reflective of Los Angeles and Fresno Counties residence for about 44% of IHSS recipients. The model includes only recipients who have a spouse present, n shown in the column heading is the number of Spouse providers, n shown in the Spouse Present row is the number of spouses available in the IHSS recipient sample. “na” is not applicable.

TABLE C-3: Predicting Provider Relationships, IHSS Recipients 65+ or More, 2005
Total Recipients n=233,856	Provider Relationship
Total Recipients n=233,856	Spouse^g n=5,130		Other Relative n=123,496		Non-Relative n=104,971
Predictors	Odds Ratio	95% CI	Odds Ratio	95% CI	Odds Ratio	95% CI
Intercept
Recipient Characteristics
Female Recipient	0.23	0.21-0.24	1.38	1.35-1.41	0.85	0.84-0.87
Hispanic^a	4.75	4.37-5.17	1.13	1.10-1.16	0.76	0.75-0.78
Black^a	3.64	3.10-4.27	0.94	0.92-0.97	0.98	0.95-1.01
Asian/Other^a	2.31	2.12-2.52	1.46	1.42-1.49	0.63	0.62-0.65
3+ Cognitive Limitations^b	1.58	1.34-1.86	0.98	0.93-1.03	0.98	0.93-1.03
3+ ADL Limitations^c	7.79	7.12-8.51	1.03	1.01-1.05	0.84	0.82-0.85
Respiratory Limitations^d	1.48	1.34-1.64	0.93	0.90-0.96	1.02	0.98-1.05
Managed Care Member	1.16	1.05-1.29	1.08	1.05-1.11	0.90	0.87-0.93
Living Arrangement
Spouse Present (n=69,034)	na	na	1.10	1.08-1.12	0.68	0.66-0.69
Household size (1-5+)^e	0.88	0.86-0.91	1.60	1.59-1.61	0.63	0.62-0.63
County Measures
IHSS Wage Rate^f
<$7.50 per hour	1.99	1.80-2.20	0.79	0.77-0.81	1.16	1.12-1.19
$8 per hour	1.86	1.70-2.04	1.23	1.19-1.26	0.75	0.73-0.77
$9.50-$9.75 per hour	1.32	1.19-1.48	1.17	1.13-1.20	0.82	0.79-0.84
>$10 per hour	0.88	0.72-1.09	1.06	1.00-1.12	0.94	0.89-1.00
Per Capita Income (000’s)	1.00	1.00-1.01	0.99	0.98-0.99	1.02	1.01-1.02
New IHSS Recipients	1.32	1.22-1.44	1.02	0.99-1.04	0.95	0.93-0.97
Model Goodness of Fit
-2Log Likelihood	29,318.4		296,098.0		289,899.0
Maximum Rescaled R²	0.242		0.147		0.170
SOURCE: California Department of Social Services, unpublished CMIPS data for 2005. Reference is White. Race/ethnicity Asian/Other includes in descending order by number in this age group, Chinese, Filipino, Vietnamese, Korean, Laotian, Cambodian, Asian Indian, American Indian or Alaskan Native, Japanese, Samoan, and all others. Cognition is defined by: memory, orientation, and judgment. Each scored 1 independent; 2 able to perform, but needs verbal assistance such as reminders, guidance, or encouragement; 5 cannot perform without human assistance. Scores three and four not used. The measure is a dummy variable yes = have three cognitive measures each with a score five. ADLs refers to activities of daily living (i.e., bathing and grooming; dressing; transferring; bowel, bladder and menstrual; eating). Each task is scored on a four or five point scale: 1 and 2 as per above, 3 Can perform with some human direct physical assistance from the provider, 4 Can perform with a lot of human assistance, 5 cannot perform without human assistance. The measure is a dummy variable yes = have three or more ADLs each with a score of three or more indicating the need for human assistance. Breathing is scored 1 independent, 5 cannot perform without human assistance, 6 paramedical services needed. The measure is the presence/absence of a breathing item with a score of five or more. Number of persons in household, including other IHSS recipients, excludes recipient’s non-IHSS children <age 14. The omitted category for IHSS wages is $7.50/hr (reflective of Los Angeles and Fresno Counties residence for about 44% of IHSS recipients. The model includes only recipients who have a spouse present, n shown in the column heading is the number of Spouse providers, n shown in the Spouse Present row is the number of spouses available in the IHSS recipient sample. “na” is not applicable.

APPENDIX D. HIERARCHICAL CONDITION CLASSIFICATION AND DISTRIBUTION FOR IHSS RECIPIENTS BY AGE AND PROVIDER RELATIONSHIP

TABLE D-1: Hierarchical Condition Classification Distribution for IHSS Recipients Age 3-17 by Provider Relationship, 2005
HCC		Parents		Other Relative		Non-Relative
HCC		#	%	#	%	#	%
	Total Recipients	8,293	100.0	1,455	100.0	1,835	100.0
	Recipients w/any HCC	6,740	81.3	1,055	72.5	1,261	68.7

	Infectious and Parasitic Disease
1	HIV/AIDS	12	0.1	7	0.5	12	0.7
2	Septicemia/Shock	64	0.8	4	0.3	7	0.4
3	Central Nervous System Infection	31	0.4	3	0.2	6	0.3
4	Tuberculosis	13	0.2	8	0.5	0	-
5	Opportunistic Infections	12	0.1	1	0.1	2	0.1
6	Other Infectious Diseases	967	11.7	141	9.7	152	8.3
	NEOPLASMS
7	Metastatic Cancer & Acute Leukemia	54	0.7	8	0.5	5	0.3
8	Lung, Upper Digestive Tract, & Other Severe Cancers	11	0.1	1	0.1	0	-
9	Lymphatic, Head & Neck, Brain, and Other Major Cancers	117	1.4	10	0.7	15	0.8
10	Breast, Prostate, Colorectal & Other Cancers & Tumors	114	1.4	11	0.8	14	0.8
11	Other Respiratory & Heart Neoplasms	15	0.2	1	0.1	1	0.1
12	Other Digestive & Urinary Neoplasms	24	0.3	1	0.1	5	0.3
13	Other Neoplasms	82	1.0	7	0.5	9	0.5
14	Benign Neoplasms of Skin, Breast, Eye	49	0.6	12	0.8	9	0.5
a	Endocrine, Nutritional and Metabolic Disorders
15	Diabetes with Renal or Peripheral Circulatory Manifestation	4	0.0	1	0.1	0	-
16	Diabetes with Neurologic or Other Specified Manifestation	7	0.1	1	0.1	2	0.1
17	Diabetes with Acute Complications	6	0.1	4	0.3	4	0.2
18	Diabetes with Ophthalmologic or Unspecified Manifestation	10	0.1	1	0.1	4	0.2
19	Diabetes without Complication	101	1.2	15	1.0	13	0.7
21	Protein-Calorie Malnutrition	29	0.3	4	0.3	4	0.2
22	Other Significant Endocrine and Metabolic Disorders	193	2.3	25	1.7	26	1.4
23	Disorders of Fluid/Electrolyte/Acid-Base Balance	87	1.0	14	1.0	13	0.7
24	Other Endocrine, Metabolic, or Nutritional Disorders	417	5.0	66	4.5	61	3.3
	Liver and Gallbladder Disease
25	End-Stage Liver Disease	9	0.1	3	0.2	1	0.1
26	Cirrhosis of Liver	4	0.0	2	0.1	0	-
27	Chronic Hepatitis	7	0.1	1	0.1	0	-
28	Acute Liver Failure/Disease	3	0.0	0	-	1	0.1
29	Other Hepatitis & Liver Disease	48	0.6	6	0.4	3	0.2
30	Gallbladder & Biliary Tract Disorders	26	0.3	2	0.1	4	0.2
	Gastrointestinal Disease/Disorders
31	Intestinal Obstruction/Perforation	97	1.2	20	1.4	9	0.5
32	Pancreatic Disease	82	1.0	4	0.3	10	0.5
33	Inflammatory Bowel Disease	12	0.1	1	0.1	4	0.2
34	Peptic Ulcer, Hemorrhage, Other Specified Gastrointestinal Disorders	125	1.5	17	1.2	12	0.7
35	Appendicitis	16	0.2	5	0.3	1	0.1
36	Other Gastrointestinal Disorders	1,492	18.0	202	13.9	203	11.1
	Musculoskeletal/Connective Tissue Disease Disorders
37	Bone/Joint/Muscle Infections/Necrosis	34	0.4	9	0.6	2	0.1
38	Rheumatoid Arthritis & Inflammatory Connective Tissue Disease	56	0.7	5	0.3	13	0.7
39	Disorders of the Vertebrae & Spinal Discs	654	7.9	76	5.2	96	5.2
40	Osteoarthritis of Hip or Knee	10	0.1	1	0.1	3	0.2
41	Osteoporosis & Other Bone/Cartilage Disorders	157	1.9	20	1.4	12	0.7
42	Congenital/Developmental Skeletal and Connective Tissue Disorders	214	2.6	37	2.5	26	1.4
43	Other Musculoskeletal & Connective Tissue Disorders	1,384	16.7	175	12.0	214	11.7
	Blood and Blood Forming Organ Disease/Disorders
44	Severe Hematological Disorders	66	0.8	5	0.3	8	0.4
45	Disorders of Immunity	37	0.4	8	0.5	14	0.8
46	Coagulation Defects & Other Specified Hematological Disorders	67	0.8	9	0.6	8	0.4
47	Iron Deficiency & Other Unspecified Anemias & Blood Disease	163	2.0	27	1.9	27	1.5
	Mental Disorders
48	Delirium & Encephalopathy	147	1.8	37	2.5	15	0.8
49	Dementia/Cerebral Degeneration	319	3.8	29	2.0	43	2.3
50	Nonpsychotic Organic Brain Syndromes/Conditions	132	1.6	14	1.0	16	0.9
51	Drug/Alcohol Psychosis	1	0.0	1	0.1	0	-
52	Drug/Alcohol Dependence	3	0.0	0	-	1	0.1
53	Drug/Alcohol Abuse, Without Dependence	1	0.0	1	0.1	3	0.2
54	Schizophrenia	14	0.2	3	0.2	3	0.2
55	Major Depressive, Bipolar, and Paranoid Disorders	51	0.6	12	0.8	11	0.6
56	Reactive and Unspecified Psychosis	17	0.2	4	0.3	6	0.3
57	Personality Disorders	10	0.1	0	-	1	0.1
58	Depression	38	0.5	9	0.6	7	0.4
59	Anxiety Disorders	71	0.9	14	1.0	10	0.5
60	Other Psychiatric Disorders	214	2.6	32	2.2	40	2.2
	Mental Retardation/Developmental Disability
61	Profound Mental Retardation, Developmental Disability	87	1.0	7	0.5	10	0.5
62	Severe Mental Retardation, Developmental Disability	41	0.5	8	0.5	9	0.5
63	Moderate Mental Retardation, Developmental Disability	20	0.2	7	0.5	5	0.3
64	Mild Mental Retardation, Autism, Down's Syndrome	860	10.4	111	7.6	136	7.4
65	Other Developmental Disability	438	5.3	69	4.7	62	3.4
66	Attention Deficit Disorder	190	2.3	37	2.5	55	3.0
	Central Nervous System Injuries/Disorders
67	Quadriplegia/Other Extensive Paralysis	667	8.0	102	7.0	103	5.6
68	Paraplegia	162	2.0	36	2.5	29	1.6
69	Spinal Cord Disorders/Injuries	488	5.9	66	4.5	68	3.7
70	Muscular Dystrophy	134	1.6	14	1.0	22	1.2
71	Polyneuropathy	81	1.0	14	1.0	12	0.7
72	Multiple Sclerosis	6	0.1	0	-	1	0.1
73	Parkinson's & Huntington's Diseases	4	0.0	1	0.1	0	-
74	Seizure Disorders & Convulsions	1,583	19.1	243	16.7	267	14.6
75	Coma, Brain Compression/Anoxic Damage	45	0.5	6	0.4	6	0.3
76	Mononeuropathy, Other Neurological Conditions/Injuries	144	1.7	16	1.1	20	1.1
	Respiratory System Disorders
77	Respirator Dependence, Tracheostomy Status	148	1.8	11	0.8	19	1.0
78	Respiratory Arrest	11	0.1	1	0.1	3	0.2
79	Cardio-Respiratory Failure & Shock	284	3.4	35	2.4	45	2.5
	Cardiovascular System Disease/Disorders
80	Congestive Heart Failure	130	1.6	16	1.1	10	0.5
81	Acute Myocardial Infarction	1	0.0	0	-	1	0.1
82	Unstable Angina & Other Acute Ischemic Heart Disease	3	0.0	1	0.1	0	-
83	Angina Pectoris/Old Myocardial Infarction	4	0.0	0	-	0	-
84	Coronary Atherosclerosis/Other Chronic Ischemic Heart Disease	11	0.1	1	0.1	2	0.1
85	Heart Infection/Inflammation, Except Rheumatic	29	0.3	2	0.1	3	0.2
86	Valvular & Rheumatic Heart Disease	130	1.6	8	0.5	18	1.0
87	Major Congenital Cardiac, Circulatory Defect	97	1.2	10	0.7	8	0.4
88	Other Congenital Heart/Circulatory Disease	220	2.7	23	1.6	21	1.1
89	Hypertensive Heart & Renal Disease or Encephalopathy	12	0.1	0	-	3	0.2
90	Hypertensive Heart Disease	5	0.1	1	0.1	0	-
91	Hypertension	97	1.2	11	0.8	14	0.8
92	Specified Heart Arrhythmias	46	0.6	6	0.4	7	0.4
93	Other Heart Rhythm & Conduction Disorders	114	1.4	20	1.4	13	0.7
94	Other & Unspecified Heart Disease	84	1.0	12	0.8	5	0.3
	Cerebral and Other Vascular System Disease/Disorders
95	Cerebral Hemorrhage	24	0.3	1	0.1	6	0.3
96	Ischemic or Unspecified Stroke	21	0.3	2	0.1	4	0.2
97	Precerebral Arterial Occlusion & Transient Cerebral Ischemia	14	0.2	0	-	5	0.3
98	Cerebral Atherosclerosis & Aneurysm	11	0.1	1	0.1	2	0.1
99	Cerebrovascular Disease, Unspecified	8	0.1	1	0.1	1	0.1
100	Hemiplegia/Hemiparesis	129	1.6	21	1.4	16	0.9
101	Cerebral Palsy & Other Paralytic Syndromes	1,122	13.5	177	12.2	170	9.3
102	Speech, Language, Cognitive, Perceptual Deficits	5	0.1	1	0.1	2	0.1
103	Cerebrovascular Disease Late Effects, Unspecified	3	0.0	0	-	1	0.1
104	Vascular Disease with Complications	17	0.2	3	0.2	1	0.1
105	Vascular Disease	32	0.4	2	0.1	4	0.2
106	Other Circulatory Disease	53	0.6	5	0.3	10	0.5
	Pulmonary System Disease/Disorders
107	Cystic Fibrosis	48	0.6	10	0.7	10	0.5
108	Chronic Obstructive Pulmonary Disease	182	2.2	24	1.6	28	1.5
109	Fibrosis of Lung & Other Chronic Lung Disorders	91	1.1	12	0.8	22	1.2
110	Asthma	846	10.2	137	9.4	141	7.7
111	Aspiration & Specified Bacterial Pneumonias	146	1.8	20	1.4	28	1.5
112	Pneumococcal Pneumonia, Empyema, Lung Abscess	44	0.5	4	0.3	6	0.3
113	Viral & Unspecified Pneumonia, Pleurisy	633	7.6	86	5.9	96	5.2
114	Pleural Effusion/Pneumothorax	64	0.8	5	0.3	11	0.6
115	Other Lung Disorders	1,266	15.3	184	12.6	195	10.6
	Eyes and Vision Disorders
116	Legally Blind	24	0.3	3	0.2	5	0.3
117	Major Eye Infections, Inflammations	7	0.1	0	-	5	0.3
118	Retinal Detachment	22	0.3	1	0.1	4	0.2
119	Proliferative Diabetic Retinopathy & Vitreous Hemorrhage	0	-	0	-	1	0.1
120	Diabetic & Other Vascular Retinopathies	34	0.4	5	0.3	7	0.4
121	Retinal Disorders, Except Detachment & Vascular Retinopathies	25	0.3	3	0.2	1	0.1
122	Glaucoma	54	0.7	6	0.4	4	0.2
123	Cataract	26	0.3	6	0.4	5	0.3
124	Other Eye Disorders	1,290	15.6	160	11.0	184	10.0
	Ear, Nose, and Throat Disorders
125	Significant Ear, Nose, & Throat Disorders	46	0.6	5	0.3	7	0.4
126	Hearing Loss	218	2.6	28	1.9	24	1.3
127	Other Ear, Nose, Throat, & Mouth Disorders	3,802	45.8	556	38.2	613	33.4
	Renal System Disorders
128	Kidney Transplant Status	23	0.3	6	0.4	5	0.3
130	Dialysis Status	11	0.1	1	0.1	3	0.2
131	Renal Failure	63	0.8	6	0.4	7	0.4
132	Nephritis	16	0.2	1	0.1	0	-
	Other Genitourinary System Disorders
133	Urinary Obstruction & Retention	311	3.8	38	2.6	24	1.3
134	Incontinence	99	1.2	21	1.4	17	0.9
135	Urinary Tract Infection	384	4.6	49	3.4	56	3.1
136	Other Urinary Tract Disorders	170	2.0	22	1.5	17	0.9
137	Female Infertility	0	-	0	-	0	-
138	Pelvic Inflammatory Disease & Other Specified Female Genital Disorders	21	0.3	3	0.2	2	0.1
139	Other Female Genital Disorders	146	1.8	32	2.2	35	1.9
140	Male Genital Disorders	115	1.4	21	1.4	15	0.8
b	Pregnancy/Child Birth Complications
141	Ectopic Pregnancy	0	-	0	-	0	-
142	Miscarriage/Abortion	3	0.0	1	0.1	0	-
143	Completed Pregnancy With Major Complications	0	-	1	0.1	0	-
144	Completed Pregnancy With Complications	6	0.1	0	-	0	-
145	Completed Pregnancy Without Complications (Normal Delivery)	3	0.0	1	0.1	0	-
146	Uncompleted Pregnancy With Complications	4	0.0	1	0.1	0	-
147	Uncompleted Pregnancy With No or Minor Complications	7	0.1	1	0.1	0	-
168	Extremely Low Birthweight Neonates	0	-	0	-	0	-
169	Very Low Birthweight Neonates	0	-	0	-	0	-
170	Serious Perinatal Problem Affecting Newborn	111	1.3	15	1.0	11	0.6
171	Other Perinatal Problems Affecting Newborn	21	0.3	2	0.1	2	0.1
172	Normal, Single Birth	4	0.0	1	0.1	1	0.1
	Dermatological Disorders
148	Decubitus Ulcer of Skin	54	0.7	11	0.8	3	0.2
149	Chronic Ulcer of Skin, Except Decubitus	21	0.3	5	0.3	4	0.2
150	Extensive Third-Degree Burns	0	-	0	-	0	-
151	Other Third-Degree & Extensive Burns	3	0.0	0	-	0	-
152	Cellulitis, Local Skin Infection	313	3.8	53	3.6	53	2.9
153	Other Dermatological Disorders	969	11.7	144	9.9	150	8.2
	Fractures, Other Injuries, and Poisoning
154	Severe Head Injury	4	0.0	0	-	0	-
155	Major Head Injury	54	0.7	6	0.4	15	0.8
156	Concussion or Unspecified Head Injury	81	1.0	12	0.8	20	1.1
157	Vertebral Fractures without Spinal Cord Injury	1	0.0	1	0.1	3	0.2
158	Hip Fracture/Dislocation	105	1.3	10	0.7	25	1.4
159	Major Fracture, Except of Skull, Vertebrae, or Hip	90	1.1	13	0.9	21	1.1
160	Internal Injuries	7	0.1	1	0.1	3	0.2
161	Traumatic Amputation	9	0.1	2	0.1	0	-
162	Other Injuries	872	10.5	138	9.5	177	9.6
163	Poisonings & Allergic Reactions	135	1.6	15	1.0	23	1.3
b,c	Treatment Complications and Status
164	Major Complications of Medical Care & Trauma	280	3.4	40	2.7	36	2.0
165	Other Complications of Medical Care	83	1.0	18	1.2	9	0.5
166	Major Symptoms, Abnormalities	2,489	30.0	385	26.5	392	21.4
167	Minor Symptoms, Signs, Findings	1,686	20.3	243	16.7	277	15.1
174	Major Organ Transplant Status	41	0.5	2	0.1	3	0.2
175	Other Organ Transplant, Replacement	46	0.6	5	0.3	3	0.2
176	Artificial Openings for Feeding or Elimination	377	4.5	52	3.6	49	2.7
177	Amputation Status, Lower Limb/Amputation Complications	4	0.0	0	-	1	0.1
178	Amputation Status, Upper Limb	0	-	0	-	0	-
179	Post-Surgical States/Aftercare/Elective	1,034	12.5	121	8.3	140	7.6
	Miscellaneous
180	Radiation Therapy	9	0.1	1	0.1	0	-
181	Chemotherapy	21	0.3	1	0.1	1	0.1
182	Rehabilitation	81	1.0	14	1.0	20	1.1
183	Screening/Observation/Special Exams	2,240	27.0	334	23.0	356	19.4
184	History of Disease	52	0.6	3	0.2	7	0.4
Parent is paid as an IHSS worker for their minor child, Other Relatives (other than spouse or parent) paid as an IHSS worker for recipient, Non-Relatives refers to all other paid IHSS workers for recipient. HCC refers to the CMS hierarchical condition categories or CMS-HCC model (Pope, Kautter, Ellis, et al., 2004). The HCC provide an established standardized protocol for combining International Classification of Disease (CDC, 2007) or ICD-9 diagnostic codes. HCC’s aggregate the over 15,000 ICD-9 categories into 189 condition categories (CCs), five of which are based on beneficiary utilization of selected types of durable medical equipment (Pope, Ellis, Ash, et al., 2000). The CCs describe a broad set of similar diseases, generally organized into body systems. Another advantage is that the CCs hierarchies are designed so that a person is coded only for the most severe manifestation among the related diseases defining the CC. Within the same HCC a person is classified once. This avoids duplicative counting of related conditions. For unrelated diseases (i.e., diseases in other CCs), the number of HCC’s accumulate. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 20 in the HCC ICD-9 code file. The inconsistent number sequence within "Pregnancy/Child Birth Complications" is a result of how the contractor grouped HCCs into the body systems structure used in this table. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 173 in the HCC ICD-9 code file.

TABLE D-2: Hierarchical Condition Classification Distribution for IHSS Recipients, Age 18-64 by Provider Relationship, 2005
HCC		Spouse		Parent		Other Relatives		Non-Relative
HCC		#	%	#	%	#	%	#	%
	Total Recipients	6,721	100.0	18,749	100.0	40,603	100.0	59,429	100.0
	Recipients w/ any HCC	6,003	89.3	13,789	73.5	36,362	89.6	52,197	87.8

	Infections and Parasitic Disease
1	HIV/AIDS	55	0.8	222	1.2	523	1.3	1,987	3.3
2	Septicemia/Shock	198	2.9	280	1.5	861	2.1	1,283	2.2
3	Central Nervous System Infection	48	0.7	75	0.4	148	0.4	288	0.5
4	Tuberculosis	18	0.3	46	0.2	127	0.3	148	0.2
5	Opportunistic Infections	30	0.4	42	0.2	96	0.2	161	0.3
6	Other Infectious Diseases	508	7.6	1,139	6.1	3,119	7.7	4,927	8.3
	Neoplasms
7	Metastatic Cancer and Acute Leukemia	117	1.7	78	0.4	556	1.4	573	1.0
8	Lung, Upper Digestive Tract, and Other Severe Cancers	114	1.7	54	0.3	569	1.4	726	1.2
9	Lymphatic, Head and Neck, Brain, and Other Major Cancers	154	2.3	165	0.9	658	1.6	914	1.5
10	Breast, Prostate, Colorectal and Other Cancers and Tumors	265	3.9	253	1.3	1,589	3.9	1,931	3.2
11	Other Respiratory and Heart Neoplasms	36	0.5	25	0.1	149	0.4	183	0.3
12	Other Digestive and Urinary Neoplasms	216	3.2	137	0.7	1,115	2.7	1,568	2.6
13	Other Neoplasms	172	2.6	207	1.1	1,188	2.9	1,838	3.1
14	Benign Neoplasms of Skin, Breast, Eye	174	2.6	315	1.7	1,991	4.9	2,589	4.4
a	Endocrine, Nutritional and Metabolic Disorders
15	Diabetes with Renal or Peripheral Circulatory Manifestation	231	3.4	108	0.6	897	2.2	881	1.5
16	Diabetes with Neurologic or Other Specified Manifestation	322	4.8	213	1.1	1,608	4.0	1,984	3.3
17	Diabetes with Acute Complications	39	0.6	61	0.3	221	0.5	331	0.6
18	Diabetes with Ophthalmologic or Unspecified Manifestation	206	3.1	117	0.6	1,078	2.7	1,214	2.0
19	Diabetes without Complication	1,383	20.6	958	5.1	7,830	19.3	8,880	14.9
21	Protein-Calorie Malnutrition	32	0.5	47	0.3	92	0.2	162	0.3
22	Other Significant Endocrine and Metabolic Disorders	89	1.3	216	1.2	469	1.2	623	1.0
23	Disorders of Fluid/Electrolyte/Acid-Base Balance	182	2.7	272	1.5	999	2.5	1,408	2.4
24	Other Endocrine/Metabolic/ Nutritional Disorders	837	12.5	1,350	7.2	5,987	14.7	7,459	12.6
	Liver and Gallbladder Disease
25	End-Stage Liver Disease	77	1.1	50	0.3	318	0.8	453	0.8
26	Cirrhosis of Liver	136	2.0	97	0.5	619	1.5	897	1.5
27	Chronic Hepatitis	153	2.3	154	0.8	628	1.5	1,321	2.2
28	Acute Liver Failure/Disease	12	0.2	24	0.1	93	0.2	160	0.3
29	Other Hepatitis and Liver Disease	271	4.0	278	1.5	1,357	3.3	2,235	3.8
30	Gallbladder and Biliary Tract Disorders	106	1.0	158	0.8	771	1.9	897	1.5
	Gastrointestinal Disease
31	Intestinal Obstruction/Perforation	108	1.6	211	1.1	576	1.4	817	1.4
32	Pancreatic Disease	74	1.1	111	0.6	443	1.1	689	1.2
33	Inflammatory Bowel Disease	22	0.3	55	0.3	142	0.3	260	0.4
34	Peptic Ulcer, Hemorrhage, Other Specified Gastrointestinal Disorders	348	5.2	383	2.0	2,015	5.0	2,485	4.2
35	Appendicitis	11	0.2	27	0.1	50	0.1	61	0.1
36	Other Gastrointestinal Disorders	1,438	21.4	2,207	11.8	8,714	21.5	11,943	20.1
	Musculoskeletal/Connective Tissue
37	Bone/Joint/Muscle Infections/Necrosis	111	1.7	176	0.9	457	1.1	905	1.5
38	Rheumatoid Arthritis and Inflammatory Connective Tissue Disease	181	2.7	276	1.5	1,397	3.4	1,857	3.1
39	Disorders of the Vertebrae and Spinal Discs	561	8.3	564	3.0	3,535	8.7	5,652	9.5
40	Osteoarthritis of Hip or Knee	181	2.7	150	0.8	1,671	4.1	2,266	3.8
41	Osteoporosis and Other Bone/Cartilage Disorders	235	3.5	338	1.8	2,025	5.0	2,385	4.0
42	Congenital/Developmental Skeletal and Connective Tissue Disorders	7	0.1	49	0.3	32	0.1	92	0.2
43	Other Musculoskeletal and Connective Tissue Disorders	2,533	37.7	3,363	17.9	17,451	43.0	25,016	42.1
	Diseases of the Blood and Blood Forming Organs
44	Severe Hematological Disorders	47	0.7	114	0.6	298	0.7	459	0.8
45	Disorders of Immunity	7	0.1	37	0.2	32	0.1	113	0.2
46	Coagulation Defects and Other Specified Hematological Disorders	71	1.1	125	0.7	381	0.9	569	1.0
47	Iron Deficiency and Other/Unspecified Anemias and Blood Disease	466	6.9	568	3.0	2,649	6.5	3,344	5.6
	Mental Disorders
48	Delirium and Encephalopathy	56	0.8	187	1.0	319	0.8	522	0.9
49	Dementia/Cerebral Degeneration	128	1.9	241	1.3	553	1.4	767	1.3
50	Nonpsychotic Organic Brain Syndromes/Conditions	66	1.0	127	0.7	346	0.9	502	0.8
51	Drug/Alcohol Psychosis	13	0.2	46	0.2	130	0.3	397	0.7
52	Drug/Alcohol Dependence	33	0.5	56	0.3	209	0.5	602	1.0
53	Drug/Alcohol Abuse, Without Dependence	38	0.6	106	0.6	330	0.8	887	1.5
54	Schizophrenia	45	0.7	464	2.5	654	1.6	1,367	2.3
55	Major Depressive, Bipolar, and Paranoid Disorders	119	1.8	344	1.8	1,048	2.6	2,375	4.0
56	Reactive and Unspecified Psychosis	44	0.7	192	1.0	320	0.8	627	1.1
57	Personality Disorders	3	0.0	17	0.1	32	0.1	104	0.2
58	Depression	130	1.9	256	1.4	1,072	2.6	1,921	3.2
59	Anxiety Disorders	56	0.8	152	0.8	389	1.0	787	1.3
60	Other Psychiatric Disorders	199	3.0	452	2.4	1,313	3.2	2,492	4.2
	Mental Retardation/ Developmental Disability
61	Profound Mental Retardation/Developmental Disability	1	0.0	92	0.5	16	0.0	46	0.1
62	Severe Mental Retardation/Developmental Disability	-	-	43	0.2	11	0.0	21	0.0
63	Moderate Mental Retardation/Developmental Disability	-	-	44	0.2	26	0.1	19	0.0
64	Mild Mental Retardation, Autism, Down's Syndrome	12	0.2	826	4.4	277	0.7	422	0.7
65	Other Developmental Disability	2	0.0	164	0.9	41	0.1	106	0.2
66	Attention Deficit Disorder	4	0.1	42	0.2	23	0.1	73	0.1
	Central Nervous System Injuries/Disorders
67	Quadriplegia, Other Extensive Paralysis	65	1.0	443	2.4	145	0.4	487	0.8
68	Paraplegia	67	1.0	281	1.5	217	0.5	497	0.8
69	Spinal Cord Disorders/Injuries	84	1.2	427	2.3	318	0.8	650	1.1
70	Muscular Dystrophy	20	0.3	145	0.8	45	0.1	110	0.2
71	Polyneuropathy	13	2.1	15	0.8	574	1.4	1,031	1.7
72	Multiple Sclerosis	88	1.3	158	0.8	265	0.7	690	1.2
73	Parkinson's and Huntington's Diseases	62	0.9	49	0.3	175	0.4	236	0.4
74	Seizure Disorders and Convulsions	379	5.6	2,359	12.6	2,002	4.9	3,741	6.3
75	Coma, Brain Compression/Anoxic Damage	22	0.3	68	0.4	104	0.3	166	0.3
76	Mononeuropathy, Other Neurological Conditions/Injuries	341	5.1	573	3.1	2,211	5.4	3,469	5.8
	Respiratory System Disorders
77	Respirator Dependence/Tracheostomy Status	19	0.3	105	0.6	86	0.2	158	0.3
78	Respiratory Arrest	12	0.2	18	0.1	52	0.1	75	0.1
79	Cardio-Respiratory Failure and Shock	268	4.0	425	2.3	1,364	3.4	2,008	3.4
	Cardiovascular System
80	Congestive Heart Failure	586	8.7	481	2.6	3,331	8.2	4,258	7.2
81	Acute Myocardial Infarction	74	1.1	38	0.2	369	0.9	406	0.7
82	Unstable Angina and Other Acute Ischemic Heart Disease	179	2.7	71	0.4	1,099	2.7	1,269	2.1
83	Angina Pectoris/Old Myocardial Infarction	170	2.5	77	0.4	1,342	3.3	1,207	2.0
84	Coronary Atherosclerosis/Other Chronic Ischemic Heart Disease	635	9.4	200	1.1	3,414	8.4	3,718	6.3
85	Heart Infection/Inflammation, Except Rheumatic	46	0.7	44	0.2	237	0.6	301	0.5
86	Valvular and Rheumatic Heart Disease	367	5.5	359	1.9	2,326	5.7	2,623	4.4
87	Major Congenital Cardiac/Circulatory Defect	1	0.0	30	0.2	20	0.0	23	0.0
88	Other Congenital Heart/Circulatory Disease	26	0.4	109	0.6	181	0.4	220	0.4
89	Hypertensive Heart and Renal Disease or Encephalopathy	33	0.5	20	0.1	168	0.4	162	0.3
90	Hypertensive Heart Disease	140	2.1	89	0.5	1,290	3.2	1,229	2.1
91	Hypertension	1,366	20.3	1,089	5.8	10,511	25.9	11,700	19.7
92	Specified Heart Arrhythmias	221	3.3	182	1.0	1,279	3.2	1,700	2.9
93	Other Heart Rhythm and Conduction Disorders	313	4.7	312	1.7	1,784	4.4	2,333	3.9
94	Other and Unspecified Heart Disease	308	4.6	283	1.5	1,763	4.3	2,295	3.9
	Cerebral and Other Vascular Systems
95	Cerebral Hemorrhage	49	0.7	63	0.3	219	0.5	269	0.5
96	Ischemic or Unspecified Stroke	367	5.5	195	1.0	1,324	3.3	1,635	2.8
97	Precerebral Arterial Occlusion and Transient Cerebral Ischemia	239	3.6	139	0.7	1,252	3.1	1,436	2.4
98	Cerebral Atherosclerosis and Aneurysm	37	0.6	33	0.2	199	0.5	264	0.4
99	Cerebrovascular Disease, Unspecified	19	0.3	26	0.1	94	0.2	139	0.2
100	Hemiplegia/Hemiparesis	114	1.7	154	0.8	279	0.7	522	0.9
101	Cerebral Palsy and Other Paralytic Syndromes	39	0.6	755	4.0	263	0.6	667	1.1
102	Speech, Language, Cognitive, Perceptual Deficits	29	0.4	35	0.2	110	0.3	189	0.3
103	Cerebrovascular Disease Late Effects, Unspecified	48	0.7	24	0.1	168	0.4	226	0.4
104	Vascular Disease with Complications	134	2.0	111	0.6	622	1.5	806	1.4
105	Vascular Disease	386	5.7	256	1.4	2,181	5.4	2,650	4.5
106	Other Circulatory Disease	362	5.4	332	1.8	1,838	4.5	2,467	4.2
	Pulmonary System
107	Cystic Fibrosis	3	0.0	15	0.1	20	0.0	25	0.0
108	Chronic Obstructive Pulmonary Disease	470	7.0	427	2.3	3,516	8.7	5,731	9.6
109	Fibrosis of Lung and Other Chronic Lung Disorders	141	2.1	207	1.1	803	2.0	1,179	2.0
110	Asthma	325	4.8	557	3.0	2,507	6.2	3,806	6.4
111	Aspiration and Specified Bacterial Pneumonias	72	1.1	183	1.0	299	0.7	479	0.8
112	Pneumococcal Pneumonia, Empyema, Lung Abscess	49	0.7	80	0.4	212	0.5	345	0.6
113	Viral and Unspecified Pneumonia, Pleurisy	488	7.3	807	4.3	2,536	6.2	3,684	6.2
114	Pleural Effusion/Pneumothorax	156	2.3	181	1.0	787	1.9	1,033	1.7
115	Other Lung Disorders	923	13.7	1,630	8.7	5,748	14.2	7,757	13.1
	Eyes and Vision Disorders
116	Legally Blind	11	0.2	27	0.1	50	0.1	104	0.2
117	Major Eye Infections/Inflammations	9	0.1	23	0.1	49	0.1	88	0.1
118	Retinal Detachment	24	0.4	38	0.2	123	0.3	145	0.2
119	Proliferative Diabetic Retinopathy and Vitreous Hemorrhage	144	2.1	43	0.2	523	1.3	440	0.7
120	Diabetic and Other Vascular Retinopathies	137	2.0	53	0.3	744	1.8	703	1.2
121	Retinal Disorders, Except Detachment and Vascular Retinopathies	79	1.2	44	0.2	399	1.0	447	0.8
122	Glaucoma	240	3.6	184	1.0	1,458	3.6	1,675	2.8
123	Cataract	282	4.2	152	0.8	2,063	5.1	2,072	3.5
124	Other Eye Disorders	672	10.0	1,145	6.1	5,236	12.9	5,736	9.7
	Ears, Nose, and Throat Disorders
125	Significant Ear, Nose, and Throat Disorders	32	0.5	39	0.2	192	0.5	258	0.4
126	Hearing Loss	57	0.8	141	0.8	373	0.9	628	1.1
127	Other Ear, Nose, Throat, and Mouth Disorders	1,315	19.6	3,826	20.4	8,381	20.6	11,597	19.5
	Renal System
128	Kidney Transplant Status	65	1.0	86	0.5	207	0.5	225	0.4
130	Dialysis Status	257	3.8	181	1.0	849	2.1	824	1.4
131	Renal Failure	742	11.0	485	2.6	2,549	6.3	2,686	4.5
132	Nephritis	37	0.6	46	0.2	177	0.4	180	0.3
	Other Genitourinary System
133	Urinary Obstruction and Retention	328	4.9	706	3.8	1,307	3.2	2,063	3.5
134	Incontinence	70	1.0	162	0.9	545	1.3	783	1.3
135	Urinary Tract Infection	543	8.1	1,064	5.7	3,114	7.7	4,629	7.8
136	Other Urinary Tract Disorders	394	5.9	454	2.4	1,842	4.5	2,347	3.9
137	Female Infertility	-	-	1	0.0	3	0.0	8	0.0
138	Pelvic Inflammatory Disease and Other Specified Female Genital Disorders	78	1.2	159	0.8	662	1.6	821	1.4
139	Other Female Genital Disorders	279	4.2	718	3.8	3,302	8.1	4,013	6.8
140	Male Genital Disorders	232	3.5	201	1.1	719	1.8	1,206	2.0
b	Pregnancy/Child Birth Complications
141	Ectopic Pregnancy	4	0.1	2	0.0	6	0.0	6	0.0
142	Miscarriage/Abortion	10	0.1	34	0.2	47	0.1	110	0.2
143	Completed Pregnancy With Major Complications	5	0.1	17	0.1	14	0.0	35	0.1
144	Completed Pregnancy With Complications	11	0.2	38	0.2	38	0.1	115	0.2
145	Completed Pregnancy Without Complications (Normal Delivery)	13	0.2	41	0.2	35	0.1	105	0.2
146	Uncompleted Pregnancy w/complications	13	0.2	35	0.2	39	0.1	116	0.2
147	Uncompleted Pregnancy With No or Minor Complications	31	0.5	98	0.5	103	0.3	268	0.5
168	Extremely Low Birthweight Neonates	2	0.0	-	-	1	0.0	1	0.0
169	Very Low Birthweight Neonates	-	-	1	0.0	1	0.0	2	0.0
170	Serious Perinatal Problem Affecting Newborn	4	0.1	18	0.1	30	0.1	57	0.1
171	Other Perinatal Problems Affecting Newborn	3	0.0	18	0.1	29	0.1	48	0.1
172	Normal, Single Birth	13	0.2	41	0.2	35	0.1	108	0.2
	Dermatological Disorders
148	Decubitus Ulcer of Skin	93	1.4	266	1.4	351	0.9	819	1.4
149	Chronic Ulcer of Skin, Except Decubitus	199	3.0	248	1.3	826	2.0	1,366	2.3
150	Extensive Third-Degree Burns	-	-	-	-	-	-	7	0.0
151	Other Third-Degree and Extensive Burns	6	0.1	6	0.0	16	0.0	55	0.1
152	Cellulitis, Local Skin Infection	496	7.4	934	5.0	2,720	6.7	5,032	8.5
153	Other Dermatological Disorders	647	9.6	1,716	9.2	4,779	11.8	7,398	12.4
	Fractures, Other Injuries and Poisoning
154	Severe Head Injury	2	0.0	9	0.0	10	0.0	24	0.0
155	Major Head Injury	46	0.7	169	0.9	215	0.5	440	0.7
156	Concussion or Unspecified Head Injury	82	1.2	177	0.9	445	1.1	858	1.4
157	Vertebral Fractures without Spinal Cord Injury	30	0.4	41	0.2	181	0.4	351	0.6
158	Hip Fracture/Dislocation	47	0.7	101	0.5	268	0.7	595	1.0
159	Major Fracture, Except of Skull, Vertebrae, or Hip	92	1.4	172	0.9	515	1.3	1,037	1.7
160	Internal Injuries	14	0.2	38	0.2	81	0.2	141	0.2
161	Traumatic Amputation	60	0.9	62	0.3	175	0.4	296	0.5
162	Other Injuries	1,033	15.4	1,932	10.3	6,048	14.9	11,126	18.7
163	Poisonings and Allergic Reactions	186	2.8	340	1.8	948	2.3	1,795	3.0
b,c	Treatment Complications and Status
164	Major Complications of Medical Care and Trauma	298	4.4	444	2.4	1,217	3.0	1,805	3.0
165	Other Complications of Medical Care	113	1.7	183	1.0	572	1.4	911	1.5
166	Major Symptoms, Abnormalities	2,756	41.0	3,993	21.3	16,897	41.6	23,250	39.1
167	Minor Symptoms, Signs, Findings	2,318	34.5	3,609	19.2	14,745	36.3	20,037	33.7
174	Major Organ Transplant Status	52	0.8	55	0.3	140	0.3	165	0.3
175	Other Organ Transplant/Replacement	29	0.4	39	0.2	103	0.3	109	0.2
176	Artificial Openings for Feeding or Elimination	81	1.2	245	1.3	280	0.7	422	0.7
177	Amputation Status, Lower Limb/Amputation Complications	44	0.7	35	0.2	137	0.3	229	0.4
178	Amputation Status, Upper Limb	-	-	-	-	2	0.0	4	0.0
179	Post-Surgical States/Aftercare/Elective	563	8.4	994	5.3	2,715	6.7	4,531	7.6
	Miscellaneous
180	Radiation Therapy	25	0.4	17	0.1	154	0.4	190	0.3
181	Chemotherapy	5	0.1	14	0.1	70	0.2	74	0.1
182	Rehabilitation	205	3.1	273	1.5	772	1.9	1,488	2.5
183	Screening/Observation/Special Exams	1,969	29.3	3,924	20.9	13,199	32.5	18,994	32.0
184	History of Disease	100	1.5	95	0.5	495	1.2	753	1.3
Parent is paid as an IHSS worker for their adult child, Spouse is paid as an IHSS worker for recipient, Other Relatives (other than spouse or parent) paid as an IHSS worker for recipient, Non-Relatives refers to all other paid IHSS workers for recipient. HCC refers to the CMS hierarchical condition category or CMS-HCC model (Pope, Kautter, Ellis, et al., 2004). The HCC provide an established standardized protocol for combining International Classification of Disease (CDC, 2007) or ICD-9 diagnostic codes. HCCs aggregate the over 15,000 ICD-9 categories into 189 condition categories (CCs), five of which are based on beneficiary utilization of selected types of durable medical equipment (Pope, Ellis, Ash, et al., 2000). The CCs describe a broad set of similar diseases, generally organized into body systems. Another advantage is that the CC hierarchies are designed so that a person is coded only for the most severe manifestation among the related diseases defining the CC. Within the same HCC a person is classified once. This avoids duplicative counting of related conditions. For unrelated diseases (i.e., diseases in other CCs), the number of HCCs accumulate. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 20 in the HCC ICD-9 code file. The inconsistent number sequence within "Pregnancy/Child Birth Complications" is a result of how the contractor grouped HCCs into the body systems structure used in this table. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 173 in the HCC ICD-9 code file.

TABLE D-3: Hierarchical Condition Classification Distribution for IHSS Recipients Age 65+ by Provider Relationship, 2005
HCC		Parents		Other Relative		Non-Relative
HCC		#	%	#	%	#	%
	Total Recipients	4,656	100.0	109,260	100.0	95,551	100.0
	Recipients w/any HCC	3,847	82.6	91,221	83.5	80,167	83.9

	Infections and Parasitic Disease
1	HIV/AIDS	3	0.1	27	0.0	75	01
2	Septicemia/Shock	119	2.6	1,781	1.6	1,389	1.5
3	Central Nervous System Infection	9	0.2	96	0.1	107	0.1
4	Tuberculosis	14	0.3	192	0.2	106	0.1
5	Opportunistic Infections	14	0.3	94	0.1	75	0.1
6	Other Infectious Diseases	192	4.1	4,263	3.9	5,017	5.3
	Neoplasms
7	Metastatic Cancer and Acute Leukemia	65	1.4	971	0.9	868	0.9
8	Lung, Upper Digestive Tract, and Other Severe Cancers	97	2.1	1,572	1.4	1,436	1.5
9	Lymphatic, Head and Neck, Brain, and Other Major Cancers	82	1.8	1,182	1.1	1,078	1.1
10	Breast, Prostate, Colorectal and Other Cancers and Tumors	259	5.6	4,206	3.8	4,107	4.3
11	Other Respiratory and Heart Neoplasms	24	0.5	237	0.2	234	0.2
12	Other Digestive and Urinary Neoplasms	167	3.6	3,271	3.0	3,170	3.3
13	Other Neoplasms	56	1.2	1,435	1.3	1,665	1.7
14	Benign Neoplasms of Skin, Breast, Eye	45	1.0	2,181	2.0	2,589	2.7
a	Endocrine, Nutritional and Metabolic Disorders
15	Diabetes with Renal or Peripheral Circulatory Manifestation	109	2.3	1,171	1.1	1,010	1.1
16	Diabetes with Neurologic or Other Specified Manifestation	178	3.8	2,181	2.0	1,919	2.0
17	Diabetes with Acute Complications	8	0.2	161	0.1	153	0.2
18	Diabetes with Ophthalmologic or Unspecified Manifestation	78	1.7	915	0.8	762	0.8
19	Diabetes without Complication	580	12.5	9,905	9.1	8,322	8.7
21	Protein-Calorie Malnutrition	14	0.3	186	0.2	140	0.1
22	Other Significant Endocrine and Metabolic Disorders	25	0.5	341	0.3	318	0.3
23	Disorders of Fluid/Electrolyte/Acid-Base Balance	103	2.2	1,529	1.4	1,406	1.5
24	Other Endocrine/Metabolic/Nutritional Disorders	217	4.7	5,687	5.2	5,007	5.2
	Liver and Gallbladder Disease
25	End-Stage Liver Disease	18	0.4	186	0.2	142	0.1
26	Cirrhosis of Liver	39	0.8	384	0.4	321	0.3
27	Chronic Hepatitis	14	0.3	198	0.2	174	0.2
28	Acute Liver Failure/Disease	5	0.1	61	0.1	49	0.1
29	Other Hepatitis and Liver Disease	60	1.3	1,050	1.0	844	0.9
30	Gallbladder and Biliary Tract Disorders	73	1.6	1,383	1.3	1,128	1.2
	Gastrointestinal Disease/Disorders
31	Intestinal Obstruction/Perforation	77	1.7	1,096	1.0	1,083	1.1
32	Pancreatic Disease	41	0.9	651	0.6	590	0.6
33	Inflammatory Bowel Disease	12	0.3	147	0.1	160	0.2
34	Peptic Ulcer, Hemorrhage, Other Specified Gastrointestinal Disorders	194	4.2	3,758	3.4	3,435	3.6
35	Appendicitis	5	0.1	79	0.1	65	0.1
36	Other Gastrointestinal Disorders	669	14.4	14,064	12.9	13,445	14.1
	Musculoskeletal/Connective Tissue Disease/Disorders
37	Bone/Joint/Muscle Infections/Necrosis	50	1.1	473	0.4	434	0.5
38	Rheumatoid Arthritis & Inflammatory Connective Tissue Disease	57	1.2	1,032	0.9	1,171	1.2
39	Disorders of the Vertebrae and Spinal Discs	238	5.1	5,441	5.0	5,940	6.2
40	Osteoarthritis of Hip or Knee	102	2.2	3,567	3.3	3,467	3.6
41	Osteoporosis and Other Bone/Cartilage Disorders	89	1.9	3,471	3.2	3,321	3.5
42	Congenital/Developmental Skeletal and Connective Tissue Disorders	1	0.0	19	0.0	20	0.0
43	Other Musculoskeletal and Connective Tissue Disorders	1,037	22.3	28,437	26.0	27,887	29.2
	Blood and Blood Forming Organ Disease/Disorders
44	Severe Hematological Disorders	32	0.7	5	0.6	470	0.5
45	Disorders of Immunity	1	0.0	16	0.0	19	0.0
46	Coagulation Defects and Other Specified Hematological Disorders	22	0.5	390	0.4	393	0.4
47	Iron Deficiency and Other/Unspecified Anemias and Blood Disease	239	5.1	4,647	4.3	4,316	4.5
	Mental Disorders
48	Delirium and Encephalopathy	18	0.4	293	0.3	298	0.3
49	Dementia/Cerebral Degeneration	167	3.6	3,510	3.2	3,091	3.2
50	Nonpsychotic Organic Brain Syndromes/Conditions	30	0.6	570	0.5	517	0.5
51	Drug/Alcohol Psychosis	5	0.1	42	0.0	89	0.1
52	Drug/Alcohol Dependence	4	0.1	28	0.0	83	0.1
53	Drug/Alcohol Abuse, Without Dependence	7	0.2	82	0.1	151	0.2
54	Schizophrenia	5	0.1	133	0.1	186	0.2
55	Major Depressive, Bipolar, and Paranoid Disorders	23	0.5	711	0.7	936	1.0
56	Reactive and Unspecified Psychosis	18	0.4	319	0.3	301	0.3
57	Personality Disorders	-	-	8	0.0	12	0.0
58	Depression	19	0.4	488	0.4	546	0.6
59	Anxiety Disorders	5	0.1	144	0.1	186	0.2
60	Other Psychiatric Disorders	25	0.5	678	0.6	867	0.9
	Mental Retardation/Developmental Disability
61	Profound Mental Retardation/Developmental Disability	-	-	2	0.0	2	0.0
62	Severe Mental Retardation/Developmental Disability	-	-	3	0.0	-	-
63	Moderate Mental Retardation/Developmental Disability	-	-	-	-	-	-
64	Mild Mental Retardation, Autism, Down's Syndrome	-	-	16	0.0	9	0.0
65	Other Developmental Disability	1	0.0	8	0.0	13	0.0
66	Attention Deficit Disorder	-	-	5	0.0	9	0.0
	Central Nervous System Injuries/Disorders
67	Quadriplegia, Other Extensive Paralysis	5	0.1	42	0.0	36	0.0
68	Paraplegia	7	0.2	37	0.0	43	0.0
69	Spinal Cord Disorders/Injuries	17	0.4	299	0.3	266	0.3
70	Muscular Dystrophy	-	-	4	0.0	9	0.0
71	Polyneuropathy	33	0.7	430	0.4	446	0.5
72	Multiple Sclerosis	6	0.1	30	0.0	60	0.1
73	Parkinson's and Huntington's Diseases	60	1.3	569	0.5	493	0.5
74	Seizure Disorders and Convulsions	56	1.2	897	0.8	784	0.8
75	Coma, Brain Compression/Anoxic Damage	2	0.0	86	0.1	79	0.1
76	Mononeuropathy, Other Neurological Conditions/Injuries	82	1.8	1,413	1.3	1,560	1.6
	Respiratory System Disorders
77	Respirator Dependence/Tracheostomy Status	4	0.1	59	0.1	52	0.1
78	Respiratory Arrest	3	0.1	32	0.0	23	0.0
79	Cardio-Respiratory Failure and Shock	145	3.1	1,770	1.6	1,608	1.7
	Cardiovascular System Disease/Disorders
80	Congestive Heart Failure	483	10.4	8,575	7.8	7,813	8.2
81	Acute Myocardial Infarction	72	1.5	1,322	1.2	1,074	1.1
82	Unstable Angina and Other Acute Ischemic Heart Disease	127	2.7	2,272	2.1	2,017	2.1
83	Angina Pectoris/Old Myocardial Infarction	111	2.4	2,233	2.0	1,959	2.1
84	Coronary Atherosclerosis/Other Chronic Ischemic Heart Disease	520	11.2	9,711	8.9	8,643	9.0
85	Heart Infection/Inflammation, Except Rheumatic	17	0.4	287	0.3	233	0.2
86	Valvular and Rheumatic Heart Disease	234	5.0	5,371	4.9	4,530	4.7
87	Major Congenital Cardiac/Circulatory Defect	-	-	11	0.0	5	0.0
88	Other Congenital Heart/Circulatory Disease	20	0.4	438	0.4	310	0.3
89	Hypertensive Heart and Renal Disease or Encephalopathy	17	0.4	221	0.2	160	0.2
90	Hypertensive Heart Disease	79	1.7	2,208	2.0	1,721	1.8
91	Hypertension	697	15.0	17,995	16.5	14,887	15.6
92	Specified Heart Arrhythmias	298	6.4	5,575	5.1	5,359	5.6
93	Other Heart Rhythm and Conduction Disorders	239	5.1	4,467	4.1	4,523	4.7
94	Other and Unspecified Heart Disease	172	3.7	3,303	3.0	2,864	3.0
	Cerebral and Other Vascular System Disease/Disorders
95	Cerebral Hemorrhage	47	1.0	617	0.6	485	0.5
96	Ischemic or Unspecified Stroke	274	5.9	3,714	3.4	3,195	3.3
97	Precerebral Arterial Occlusion and Transient Cerebral Ischemia	235	5.0	4,002	3.7	3,687	3.9
98	Cerebral Atherosclerosis & Aneurysm	47	1.0	896	0.8	761	0.8
99	Cerebrovascular Disease, Unspecified	4	0.1	128	0.1	145	0.2
100	Hemiplegia/Hemiparesis	41	0.9	324	0.3	257	0.3
101	Cerebral Palsy and Other Paralytic Syndromes	9	0.2	58	0.1	66	0.1
102	Speech, Language, Cognitive, Perceptual Deficits	14	0.3	183	0.2	135	0.1
103	Cerebrovascular Disease Late Effects, Unspecified	33	0.7	284	0.3	225	0.2
104	Vascular Disease with Complications	99	2.1	1,248	1.1	1,169	1.2
105	Vascular Disease	288	6.2	4,428	4.1	4,544	4.8
106	Other Circulatory Disease	185	4.0	2,891	2.6	2,887	3.0
	Pulmonary System Disease/Disorders
107	Cystic Fibrosis	-	-	3	0.0	4	0.0
108	Chronic Obstructive Pulmonary Disease	339	7.3	5,745	5.3	6,131	6.4
109	Fibrosis of Lung and Other Chronic Lung Disorders	63	1.4	1,249	1.1	1,006	1.1
110	Asthma	69	1.5	1,990	1.8	1,621	1.7
111	Aspiration and Specified Bacterial Pneumonias	68	1.5	921	0.8	716	0.7
112	Pneumococcal Pneumonia, Empyema, Lung Abscess	17	0.4	226	0.2	209	0.2
113	Viral and Unspecified Pneumonia, Pleurisy	287	6.2	5,468	5.0	4,530	4.7
114	Pleural Effusion/Pneumothorax	94	2.0	1,512	1.4	1,312	1.4
115	Other Lung Disorders	320	6.9	6,983	6.4	5,669	5.9
	Eyes and Vision Disorders
116	Legally Blind	1	0.0	48	0.0	50	0.1
117	Major Eye Infections/Inflammations	5	0.1	74	0.1	53	0.1
118	Retinal Detachment	6	0.1	106	0.1	90	0.1
119	Proliferative Diabetic Retinopathy and Vitreous Hemorrhage	34	0.7	336	0.3	238	0.2
120	Diabetic and Other Vascular Retinopathies	37	0.8	719	0.7	593	0.6
121	Retinal Disorders, Except Detachment and Vascular Retinopathies	34	0.7	1,207	1.1	1,206	1.3
122	Glaucoma	102	2.2	2,670	2.4	2,779	2.9
123	Cataract	248	5.3	6,951	6.4	6,113	6.4
124	Other Eye Disorders	330	7.1	9,446	8.6	8,061	8.4
	Ears, Nose, and Throat Disorders
125	Significant Ear, Nose, and Throat Disorders	9	0.2	172	0.2	165	0.2
126	Hearing Loss	40	0.9	906	0.8	913	1.0
127	Other Ear, Nose, Throat, and Mouth Disorders	318	6.8	7,595	7.0	6,820	7.1
	Renal System Disorders
128	Kidney Transplant Status	21	0.5	64	0.1	41	0.0
130	Dialysis Status	127	2.7	1,052	1.0	727	0.8
131	Renal Failure	381	8.2	3,845	3.5	2,875	3.0
132	Nephritis	11	0.2	119	0.1	88	0.1
	Other Genitourinary System Disorders
133	Urinary Obstruction and Retention	159	3.4	1,905	1.7	1,853	1.9
134	Incontinence	27	0.6	549	0.5	610	0.6
135	Urinary Tract Infection	177	3.8	4,232	3.9	4,021	4.2
136	Other Urinary Tract Disorders	217	4.7	2,884	2.6	2,768	2.9
137	Female Infertility	-	-	1	0.0	2	0.0
138	Pelvic Inflammatory Disease and Other Specified Female Genital Disorders	9	0.2	583	0.5	536	0.6
139	Other Female Genital Disorders	22	0.5	1,474	1.3	1,490	1.6
140	Male Genital Disorders	180	3.9	1,595	1.5	1,564	1.6
b	Pregnancy/Child Birth Complications
141	Ectopic Pregnancy	-	-	-	-	-	-
142	Miscarriage/Abortion	-	-	2	0.0	4	0.0
143	Completed Pregnancy With Major Complications	-	-	1	0.0	-	-
144	Completed Pregnancy With Complications	1	0.0	3	0.0	8	0.0
145	Completed Pregnancy Without Complications (Normal Delivery)	-	-	3	0.0	2	0.0
146	Uncompleted Pregnancy With Complications	-	-	5	0.0	2	0.0
147	Uncompleted Pregnancy With No or Minor Complications	-	-	12	0.0	9	0.0
168	Extremely Low Birth weight Neonates	-	-	-	-	-	-
169	Very Low Birth weight Neonates	-	-	-	-	-	-
170	Serious Perinatal Problem Affecting Newborn	-	-	20	0.0	23	0.0
171	Other Perinatal Problems Affecting Newborn	3	0.1	19	0.0	9	0.0
172	Normal, Single Birth	-	-	4	0.0	4	0.0
	Dermatological Disorders
148	Decubitus Ulcer of Skin	34	0.7	523	0.5	636	0.7
149	Chronic Ulcer of Skin, Except Decubitus	105	2.3	1,330	1.2	1,605	1.7
150	Extensive Third-Degree Burns	-	-	-	-	2	0.0
151	Other Third-Degree and Extensive Burns	4	0.1	23	0.0	24	0.0
152	Cellulitis, Local Skin Infection	149	3.2	2,424	2.2	2,710	2.8
153	Other Dermatological Disorders	209	4.5	7,171	6.6	8,909	9.3
	Fractures, Other Injuries and Poisoning
154	Severe Head Injury	-	-	13	0.0	14	0.0
155	Major Head Injury	23	0.5	454	0.4	368	0.4
156	Concussion or Unspecified Head Injury	34	0.7	869	0.8	855	0.9
157	Vertebral Fractures without Spinal Cord Injury	30	0.6	943	0.9	877	0.9
158	Hip Fracture/Dislocation	47	1.0	1,454	1.3	1,514	1.6
159	Major Fracture, Except of Skull, Vertebrae, or Hip	48	1.0	910	0.8	934	1.0
160	Internal Injuries	8	0.2	68	0.1	76	0.1
161	Traumatic Amputation	28	0.6	98	0.1	85	0.1
162	Other Injuries	362	7.8	8,476	7.8	8,858	9.3
163	Poisonings and Allergic Reactions	32	0.7	683	0.6	694	0.7
b,c	Treatment Complications and Status
164	Major Complications of Medical Care & Trauma	143	3.1	1,639	1.5	1,538	1.6
165	Other Complications of Medical Care	49	1.1	598	0.5	547	0.6
166	Major Symptoms, Abnormalities	1,529	32.8	31,169	28.5	29,015	30.4
167	Minor Symptoms, Signs, Findings	1,133	24.3	23,656	21.7	21,593	22.6
174	Major Organ Transplant Status	10	0.2	49	0.0	36	0.0
175	Other Organ Transplant/Replacement	7	0.2	66	0.1	56	0.1
176	Artificial Openings for Feeding or Elimination	54	1.2	708	0.6	467	0.5
177	Amputation Status, Lower Limb/Amputation Complications	10	0.2	101	0.1	98	0.1
178	Amputation Status, Upper Limb	-	-	1	0.0	1	0.0
179	Post-Surgical States/Aftercare/Elective	216	4.6	3,778	3.5	3,828	4.0
	Miscellaneous
180	Radiation Therapy	24	0.5	365	0.3	330	0.3
181	Chemotherapy	10	0.2	111	0.1	91	0.1
182	Rehabilitation	108	2.3	1,566	1.4	1,569	1.6
183	Screening/Observation/Special Exams	644	13.8	15,588	14.3	15,664	16.4
184	History of Disease	33	0.7	776	0.7	842	0.9
Spouse is paid as an IHSS worker for recipient, Other Relatives (other than spouse or parent) paid as an IHSS worker for recipient, Non-Relatives refers to all other paid IHSS workers for recipient. HCC refers to the CMS hierarchical condition category or CMS-HCC model (Pope, Kautter, Ellis, et al., 2004). The HCC provide an established standardized protocol for combining International Classification of Disease (CDC, 2007) or ICD-9 diagnostic codes. HCCs aggregate the over 15,000 ICD-9 categories into 189 condition categories (CCs), five of which are based on beneficiary utilization of selected types of durable medical equipment (Pope, Ellis, Ash, et al., 2000). The CCs describe a broad set of similar diseases, generally organized into body systems. Another advantage is that the CCs hierarchies are designed so that a person is coded only for the most severe manifestation among the related diseases defining the CC. Within the same HCC a person is classified once. For unrelated diseases (i.e., diseases in other CCs), the number of HCCs accumulate. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 20 in the HCC ICD-9 code file. The inconsistent number sequence within "Pregnancy/Child Birth Complications" is a result of how the contractor grouped HCCs into the body systems structure used in this table. The computer code used for creating the HCC groupings from ICD-9 coding was downloaded from the CMS website as a SAS program in 2007. The program code did not include HCC 173 in the HCC ICD-9 code file.

TABLE D-4: Ambulatory Care Sensitive Conditions by Provider Relationship, Recipients Ages 3-17, 2005
	Provider Relationship
	# Recipients	Spouse	Parent	Other Relative	Non-Relative
Total Recipients Age 3-17	11,002		7,845	1,449	1,768
Total Recipients w/any Hospitalization	1,439	na	1,118	166	155
Total Recipients w/any ACSC Stay	171	na	128	19	24
ACSC Inpatient Diagnoses
Accidental puncture and laceration	3	na	1	1	1
Decubitus ulcer	4	na	3	-	1
Foreign body left in after procedure	-	na	-	-	-
Iatrogenic pneumothorax in non-neonates	1	na	-	1	-
Postoperative hemorrhage & hematoma	5	na	3	1	1
Postoperative respiratory failure	35	na	28	3	4
Postoperative sepsis	7	na	4	1	2
Selected infection due to medical care	13	na	13	-	-
Transfusion reaction	-	na	-	-	-
Asthma admission rate	34	na	22	5	7
Diabetes short-term complication admission rate	5	na	2	-	3
Gastroenteritis admission rate	33	na	26	4	3
Perforated appendix admission rate	5	na	5	-	-
Urinary tract infection admission rate	34	na	27	3	4
Ambulatory Care Sensitive Conditions (ACSCs) for those <age 18 are also referred to as Pediatric Quality Indicators (PQIs) (see http://qualityindicators.ahrq.gov). Recipient counts are limited to IHSS recipients not in Medicaid managed care during calendar year 2005. Recipients of Spouse providers were excluded from the analysis. PQIs related to new births, and those <age 3 are not included. Available claims data did not permit the assignment of PQIs for pediatric heart surgery mortality, pediatric heart surgery volume, and postoperative wound dehiscence.

TABLE D-5: Ambulatory Care Sensitive Conditions by Provider Relationship, Recipients Ages 18 and Older, 2005
Recipients Age 18-64	Provider Relationship
Recipients Age 18-64	# Recipients	Spouse	Parent	Other Relative	Non-Relative
Total Recipients Age 18-64	123,813	6,282	18,625	40,304	58,602
Total Recipients w/any Hospitalization	28,881	1,923	2,627	9,468	14,863
Total Recipients w/any ACSC Stay	8,046	530	609	2,804	4,103
ACSC Inpatient Diagnoses
Diabetes, short-term complication	277	18	39	78	142
Perforated Appendix	26	4	4	10	8
Diabetes, long-term complication	1,141	105	71	438	527
COPD	1,080	37	33	355	655
Hypertension*	172	8	2	75	87
Congestive Heart Failure*	1,897	142	94	724	937
Dehydration	396	23	36	114	223
Bacterial Pneumonia	2,069	127	226	676	1,040
Urinary Infection**	1,045	80	138	320	509
Angina*	197	9	7	82	99
Diabetes, uncontrolled	167	11	8	54	94
Adult Asthma	847	37	41	292	477
Lower Extremity Amputation***	17	2	1	7	7
Recipients Age 65+	Provider Relationship
Recipients Age 65+	# Recipients	Spouse	Parent	Other Relative	Non-Relative
Total Recipients Age 65 or Older	206,579	4,156	na	108,371	94,052
Total Recipients w/any Hospitalization	57,188	1,480	na	28,602	27,106
Total Recipients w/any ACSC Stay	17,507	451	na	8,884	8,172
ACSC Inpatient Diagnoses
Diabetes, short-term complication	109	1	na	57	51
Perforated Appendix	51	-	na	28	23
Diabetes, long-term complication	1,394	70	na	700	624
COPD	1,767	41	na	786	940
Hypertension*	415	2	na	205	208
Congestive Heart Failure*	5,410	151	na	2,780	2,479
Dehydration	1,123	23	na	532	568
Bacterial Pneumonia	5,021	130	na	2,660	2,231
Urinary Infection**	2,277	38	na	1,169	1,070
Angina*	308	9	na	144	155
Diabetes, uncontrolled	163	7	na	84	72
Adult Asthma	1,122	19	na	608	495
Lower Extremity Amputation***	5	-	na	3	2
Ambulatory Care Sensitive Conditions (ACSCs) for those age 18 and over are also referred to as Prevention Quality Indicators (see http://qualityindicators.ahrq.gov). Recipient counts are limited to IHSS recipients not in Medicaid managed care during calendar year 2005. Recipients of Parent providers were excluded from the analysis. * The records with cardiac procedure codes can be included in the table. The records with immunocompromised state procedure codes can be included in the table. * The following ICD-9 codes were used: 3536, 9059, 99760~99762, 99769, V4970~V4977, V521.

APPENDIX E. PHYSICIAN, OUTPATIENT DEPARTMENT, AND EMERGENCY ROOM USE AND EXPENDITURES

TABLE E-1: Adjusted Medicaid-Paid Medical Care Use, Excluding Emergency Room Use, by IHSS Recipients,^a 2005
Predictors	Age 3-17 n=11,002		Age 18-64 n=123,813		Age 65 or More n=206,579
Predictors	Odds Ratio	95% CI	Odds Ratio	95% CI	Odds Ratio	95% CI
Recipient Characteristics
Female Recipient	0.94	0.76-1.15	0.95	0.90-1.01	0.94	0.91-0.98
Hispanic^b	1.23	0.96-1.57	1.12	1.04-1.20	0.99	0.94-1.03
Black	1.21	0.90-1.61	0.95	0.89-1.01	0.76	0.72-0.80
Asian/Other	1.08	0.75-1.54	1.23	1.11-1.36	0.99	0.95-1.04
Household size (1-5)	1.03	0.93-1.13	0.97	0.95-1.00	1.03	1.01-1.04
3+ Cognitive Limitations^c	1.41	1.07-1.86	0.98	0.88-1.09	0.98	0.88-1.09
3+ ADL Limitations^d	0.78	0.59-1.02	0.92	0.86-0.98	0.92	0.88-0.96
Respiratory Limitations^e	0.71	0.52-0.98	0.85	0.76-0.96	0.83	0.77-0.90
Number Health Conditions^f	32.8	27.3-39.3	10.6	10.2-11.0	7.54	7.37-7.71
Provider Relationship^g
Spouse	na	na	1.99	1.69-2.33	1.48	1.29-1.71
Parent	1.73	1.35-2.22	0.86	0.80-0.93	na	na
Other Relative	0.96	0.69-1.34	1.10	1.03-1.18	1.08	1.04-1.12
Total Authorized Hours	1.00	1.00-1.00	1.00	1.00-1.00	1.00	1.00-1.00
County Characteristics
Per Capita Income	0.98	0.97-1.00	0.99	0.99-0.99	1.00	1.00-1.00
New IHSS Recipients	0.12	0.09-0.17	0.06	0.06-0.07	0.04	0.04-0.04
Model Goodness of Fit
-2Log Likelihood	2728		35594		89729
Maximum Rescaled R²	0.838		0.735		0.661
SOURCE: Unpublished tables derived from California Department of Health Care Services, Medicaid claims. Events shown under count actual use as they exclude stays paid for fully by non-Medicaid sources. Sample includes all eligible IHSS recipients, excluding those in managed care for one month or more in 2005. Any ER user counts were as follows: age 3-17, age 18-64, age 65+. Reference is White. Cognition is defined by: memory, orientation, and judgment. Each scored 1 independent; 2 able to perform, but needs verbal assistance such as reminders, guidance, or encouragement; 5 cannot perform without human assistance. Scores three and four not used. The measure is a dummy variable yes = have three cognitive measures each with a score five. ADLs refers to activities of daily living (i.e., bathing and grooming; dressing; transferring; bowel, bladder and menstrual; eating). Each task is scored on a four or five point scale: 1 and 2 as per above, 3 Can perform with some human direct physical assistance from the provider, 4 Can perform with a lot of human assistance, 5 cannot perform without human assistance. The measure is a dummy variable yes = have three or more ADLs each with a score of three or more indicating the need for human assistance. Breathing is scored 1 independent, 5 cannot perform without human assistance, 6 paramedical services needed. The measure is the presence/absence of a breathing item with a score of five or more. Unduplicated count of health conditions grouped into 23 subcategories using HCCs. Reference is Non-Relative provider, "na" means the provider type was not included in the model.

TABLE E-2: Mean Medicaid-Paid Physician Expenditures by IHSS Recipients,^a 2005
Variable	Age 3-17			Age 18-64			Age 65 or More
Variable	n	Mean	Std Dev	n	Mean	Std Dev	n	Mean	Std Dev
All Recipients	8,534			102,857			161,276
Grand Total		1,057	2,379		1,126	2,884		317	1,391
Average $/month		110	343		136	458		35	188
Spouse	na			5,804			3,543
Period Mean Total $		na	na		1,240	3,556		415	1,747
Average $/month		na	na		148	474		48	242
Parent	6,424			13,010			na
Period Mean Total $		1,104	2,483		754	2,007		na	na
Average $/month		111	362		81	258		na	na
Other Relative	992			34,881			84,007
Period Mean Total $		944	1,829		1,227	3,159		311	1,350
Average $/month		96	211		143	474		35	193
Non-Relative	1,118			49,162			73,726
Period Mean Total $		887	2,179		1,139	2,779		319	1,418
Average $/month		112	324		145	485		35	179
Continuing Recipients	7,566			87,634			145,053
Grand Total		1,085	2,381		1,120	2,815		316	1,407
Average $/month		106	332		121	419		32	172
Spouse	na			4,928			2,996
Period Mean Total $		na	na		1,198	3,422		414	1,809
Average $/month		na	na		128	441		41	167
Parent	5,768			11,933			na
Period Mean Total $		1,131	2,492		730	1,943		na	na
Average $/month		108	359		73	232		na	na
Other Relative	863			29,133			74,883
Period Mean Total $		948	1,742		1,225	3,073		306	1,346
Average $/month		91	176		128	444		31	169
Non-Relative	935			41,640			67,174
Period Mean Total $		927	2,176		1,148	2,748		322	1,452
Average $/month		101	262		129	439		33	175
New IHSS Recipients	968			15,223			16,223
Grand Total		838	2,349		1,161	3,254		329	1,240
Average $/month		142	415		224	631		62	296
Spouse	na			876			547
Period Mean Total $		na	na		1,475	4,230		416	1,359
Average $/month		na	na		255	617		86	475
Parent	656			1,077			na
Period Mean Total $		866	2,396		1,019	2,600		na	na
Average $/month		138	385		169	446		na	na
Other Relative	129			5,748			9,124
Period Mean Total $		917	2,336		1,236	3,563		350	1,381
Average $/month		129	367		214	596		63	330
Non-Relative	183			7,522			6,552
Period Mean Total $		682	2,187		1,087	2,941		293	997
Average $/month		167	535		235	678		59	215
SOURCE: Derived from the California Department of Health Care Services, Medicaid claims, vendor group 5 (physicians, and physician groups, nurse practitioner, surgi-centers, rural health clinics). Sample includes all eligible IHSS recipients, excluding those in managed care for one month or more in 2005. The number of care recipients does not equal the number of eligible recipients due to the absence of vendor group 5 claims.

TABLE E-3: Mean Medicaid-Paid Outpatient Department Expenditures by IHSS Recipients,^a 2005
Variable	Age 3-17			Age 18-64			Age 65 or More
Variable	n	Mean	Std Dev	n	Mean	Std Dev	n	Mean	Std Dev
All Recipients	6,476			72,861			98,875
Grand Total		965	8,633		574	2,856		179	628
Average $/month		95	740		67	322		20	77
Spouse	na			4,141			2,402
Period Mean Total $		na	na		613	1,911		219	903
Average $/month		na	na		69	216		25	97
Parent	4,974			8,397			na
Period Mean Total $		1,037	9,783		596	6,154		na	na
Average $/month		99	831		64	567		na	na
Other Relative	700			23,456			49,490
Period Mean Total $		772	1,807		600	2,220		176	567
Average $/month		75	199		67	264		19	73
Non-Relative	802			36,867			46,983
Period Mean Total $		686	2,277		548	1,987		180	670
Average $/month		87	308		68	286		20	80
Continuing Recipients	5,853			62,189			87.846
Grand Total		985	9,060		566	2,936		179	635
Average $/month		91	769		58	295		18	75
Spouse	na			3,518			1,999
Period Mean Total $		na	na		582	1,811		206	887
Average $/month		na	na		57	169		20	81
Parent	4,534			7,676			na
Period Mean Total $		1,062	10,231		590	6,389		na	na
Average $/month		97	867		58	561		na	na
Other Relative	633			19,706			43,475
Period Mean Total $		748	1,664		588	2,143		175	556
Average $/month		69	164		59	223		18	69
Non-Relative	686			31,289			42,372
Period Mean Total $		699	2,402		544	1,964		182	693
Average $/month		72	242		59	247		19	81
New IHSS Recipients	623			10,672			11,029
Grand Total		774	1,865		621	2,335		176	569
Average $/month		131	351		120	443		32	93
Spouse	na			623			403
Period Mean Total $		na	na		789	2,393		284	978
Average $/month		na	na		136	379		50	150
Parent	440			721			na
Period Mean Total $		784	1,802		664	2,554		na	na
Average $/month		119	267		132	616		na	na
Other Relative	67			3,750			6,015
Period Mean Total $		994	2,834		663	2,587		183	640
Average $/month		132	398		113	415		31	99
Non-Relative	116			5,578			4,611
Period Mean Total $		610	1,318		569	2,108		158	395
Average $/month		176	549		120	441		31	77
SOURCE: Derived from the California Department of Health Care Services, Medicaid claims, vendor group 6 (hospital outpatient departments, organized outpatient clinics). Sample includes all eligible IHSS recipients, excluding those in managed care for one month or more in 2005. The number of care recipients does not equal the number of eligible recipients due to the absence of vendor group 6 claims.

APPENDIX F. HOME CARE AND NURSING HOME EXPENDITURES AND USE

TABLE F-1: Unadjusted Probability of Medicaid-Paid Nursing Home Stays, 2005 (Excludes IHSS Recipients in Managed Care)
Provider Type	Any Nursing Home Stays
Provider Type	No	Yes	Total	% Yes
Recipients Age 3-17
Parent	7,759	26	7,785	0.33%
Other Relative	1,446	3	1,449	0.21%
Non-Relative	1,763	5	1,768	0.28%
Total	10,968	34	11,002	0.31%
Recipients Age 18-64
Spouse	6,116	166	6,282	2.64%
Parent	18,375	250	18,625	1.34%
Other Relative	39,370	934	40,304	2.32%
Non-Relative	56,785	1,817	58,602	3.10%
Total	120,646	3,167	123,813	2.56%
Recipients Age 65 +
Spouse	3,853	303	4,156	7.29%
Other Relative	102,811	5,560	108,371	5.13%
Non-Relative	86,924	7,128	94,052	7.58%
Total	193,588	12,991	206,579	6.29%
SOURCE: Derived from Medicaid claims maintained by the California Department of Health Care Services. Nursing home use identified by vendor codes 47 (ICF-DD), and 80 (nursing facility).

TABLE F-2: Adjusted Medicaid-Paid Nursing Home Use by Adult IHSS Recipients, 2005^a (Excludes IHSS Recipients in Managed Care)
Predictors	Age 18-64 n=123,813		Age 65 or More n=206,579
Predictors	Odds Ratio	95% CI	Odds Ratio	95% CI
Intercept
Recipient Characteristics
Female Recipient	0.71	0.66-0.76	0.99	0.95-1.03
Hispanic^b	0.90	0.82-1.00	0.88	0.84-0.92
Black^b	1.01	0.92-1.10	1.18	1.12-1.25
Asian/Other^b	0.75	0.65-0.88	0.83	0.79-0.88
Householdsize (1-5)	0.97	0.94-1.01	0.96	0.94-0.97
3+ Cognitive Limitations^c	0.46	0.37-0.57	1.15	1.03-1.28
3+ ADL Limitations^d	1.42	1.30-1.56	1.34	1.28-1.40
Respiratory Limitations^e	0.95	0.84-1.08	1.02	0.95-1.09
Number Health Conditions^f	1.26	1.25-1.27	1.27	1.26-1.28
Provider Relationship^g
Spouse	0.73	0.61-0.86	0.88	0.78-1.00
Parent	0.58	0.50-0.67	na	na
Other Relative	0.81	0.74-0.88	0.74	0.71-0.77
Total Authorized Hours	1.00	1.00-1.01	1.01	1.00-1.01
County Characteristics
Per Capita Income	1.01	1.01-1.02	1.00	0.99-1.00
New IHSS Recipients	0.89	0.81-0.99	0.80	0.75-0.85
Model Goodness of Fit
-2Log Likelihood	26721		89629
Maximum Rescaled R²	0.104		0.094
SOURCE: Derived from Medicaid claims maintained by the California Department of Health Care Services. Nursing home use was identified using vendor codes 47 ICF-DD), and 80 (nursing facility). The number of nursing home users age 3-17 not included as the group was too small for reliable logistic models. Nursing home users age 18-64, or age 65+ may not equal the number of actual users, if the use was paid solely from non-Medicaid sources. Sample includes all eligible IHSS recipients, excluding those in managed care for one month or more in 2005. Reference is White. Cognition is defined by: memory, orientation, and judgment. Each scored 1 independent; 2 able to perform, but needs verbal assistance such as reminders, guidance, or encouragement; 5 cannot perform without human assistance. Scores three and four not used. The measure is a dummy variable yes = have three cognitive measures each with a score five. ADLs refers to activities of daily living (i.e., bathing and grooming; dressing; transferring; bowel, bladder and menstrual; eating). Each task is scored on a four or five point scale: 1 and 2 as per above, 3 Can perform with some human direct physical assistance from the provider, 4 Can perform with a lot of human assistance, 5 cannot perform without human assistance. The measure is a dummy variable yes = have three or more ADLs each with a score of three or more indicating the need for human assistance. Breathing is scored 1 independent, 5 cannot perform without human assistance, 6 paramedical services needed. The measure is the presence/absence of a breathing item with a score of five or more. HCC refers to Hierarchical Condition Classification, collapsed into 23 subgroups, count is unduplicated number of these groupings. Reference is Non-Relative provider, “na” means the provider type was not included in the model.

TABLE F-3: Logarithm Transformed Mean Medicaid-Paid Monthly HCBS Waiver Expenditures by IHSS Recipients, 2005^a
Predictors	Provider Relationship
	Age 3-17^g n=50		Age 18-64 n=5,258		Age 65+ n=35,205
	B	Pr > \|t\|	B	Pr > \|t\|	B	Pr > \|t\|
Intercept	4.877	*	5.903	****	6.077	****
Recipient Characteristics^b
Female Recipient	0.477		-0.110	*	-0.064	****
Hispanic	0.281		-0.066		-0.316	****
Black^a	0.885		-0.071		-0.304	****
Asian/Other	-1.399		0.147		-0.060	****
3+ Cognitive Limitations^c	-0.492		0.124		0.059
3+ ADL Limitations^d	-1.357		0.154	**	0.112	****
Respiratory Limitations^e	-1.626	*	0.793	****	-0.133	****
Household size (1-5+)^f	0.334		0.014		0.014	*
Sum HCCs^g	0.099		-0.040	****	-0.025	****
IHSS Providers^h
Spouse Provider	na		0.208		-0.079
Parent Provider	-0.256		0.422	***	na
Relative Provider	0.126		-0.019		0.069	****
Total Authorized Hours	0.002		0.000		-0.000	***
County Characteristics
Per Capita Income	-0.012		0.008	*	0.006	****
>Interactions
Spouse x Sum HCC	na		-0.049		0.004
Parent x Sum HCC	0.003		-0.019		na
Relative x Sum HCC	-0.043		-0.004		-0.009	*
New IHSS Recipients	0.998		0.313	****	0.407	****
Model Goodness of Fit
Adjusted R²	0.050		0.053	****	0.049	****
* p<0.05, p<0.01, * p<0.001, ** p<0.0001 SOURCE**: Derived from California Department of Health Care Services, Medicaid claims, 2005, vendor codes 71 (HCBS), 73 (AIDS waiver), 81 (MSSP). Sample includes all eligible IHSS recipients, excluding those in managed care for one month or more in 2005. The Medicaid expenditures used as the basis for this analysis include reimbursement for personal assistance/home care. Reference is White. Cognition is defined by: memory, orientation, and judgment. Each scored 1 independent; 2 able to perform, but needs verbal assistance such as reminders, guidance, or encouragement; 5 cannot perform without human assistance. Scores three and four not used. The measure is a dummy variable yes = have three cognitive measures each with a score five. ADLs refers to activities of daily living (i.e., bathing and grooming; dressing; transferring; bowel, bladder and menstrual; eating). Each task is scored on a four or five point scale: 1 and 2 as per above, 3 Can perform with some human direct physical assistance from the provider, 4 Can perform with a lot of human assistance, 5 Cannot perform without human assistance. The measure is a dummy variable yes = have three or more ADLs each with a score of three or more indicating the need for human assistance. Breathing is scored 1 independent, 5 cannot perform without human assistance, 6 paramedical services needed. The measure is the presence/absence of a breathing item with a score of five or more. Number of persons in household, including other IHSS recipients, excludes non-IHSS children <age 14. HCC refers to Hierarchical Condition Classification, collapsed into 23 subgroups, count is unduplicated number of these groupings. Reference is Non-Relative provider, “na” means the provider type was not included in the model.

TABLE F-4: Logarithm Transformed Mean Monthly Medicaid-Paid IHSS Expenditures by IHSS Recipients, 2005^a
Predictors	Age 3-17^g n=3,936		Age 18-64 n=114,626		Age 65+ n=198,593
Predictors	B	Pr > \|t\|	B	Pr > \|t\|	B	Pr > \|t\|
Intercept	4.938	****	5.021	****	4.993	****
Recipient Characteristics^b
Female Recipient	0.097	****	0.032	****	0.028	****
Hispanic	0.051		0.071	****	0.004
Black ^a	0.058		0.131	****	0.047	****
Asian/Other	0.101	*	0.077	****	0.004	****
3+ Cognitive Limitations^c	-0.274	****	-0.497	****	-0.690	****
3+ ADL Limitations^d	0.424	****	0.259	****	0.209	****
Respiratory Limitations^e	0.101	**	0.040	****	-0.022	****
Household size (1-5+)^f	-0.018		-0.021	****	-0.012	****
Sum HCCs^g	0.012		0.001		-0.003	****
IHSS Providers^h
Spouse Provider	na		-0.945		-0.921	****
Parent Provider	-0.900	****	-0.053	****	na
Relative Provider	0.083	*	0.062	****	0.054	****
Total Authorized Hours	0.008	****	0.010	****	0.011	****
County Characteristics
Per Capita Income	0.012	****	0.011	****	0.012	****
Interactions
Spouse x Sum HCC	na		0.005		-0.004
Parent x Sum HCC	-0.004		-0.001		na
Relative x Sum HCC	-0.010		0.000		0.003	***
New IHSS Recipients	0.023		0.060	****	0.037	****
Model Goodness of Fit
Adjusted R²	0.478	****	0.644	****	0.638	****
* p<0.05, p<0.01, * p<0.001, ** p<0.0001 SOURCE**: Derived from California Department of Health Care Services, Medicaid claims, 2005, vendor code 89 (IHSS). Sample includes all eligible IHSS recipients, excluding those in managed care for one month or more in 2005. The Medicaid expenditures used as the basis for this analysis include reimbursement for personal assistance/home care. Reference is White. Cognition is defined by: memory, orientation, and judgment. Each scored 1 independent; 2 able to perform, but needs verbal assistance such as reminders, guidance, or encouragement; 5 cannot perform without human assistance. Scores three and four not used. The measure is a dummy variable yes = have three cognitive measures each with a score five. ADLs refers to activities of daily living (i.e., bathing and grooming; dressing; transferring; bowel, bladder and menstrual; eating). Each task is scored on a four or five point scale: 1 and 2 as per above, 3 Can perform with some human direct physical assistance from the provider, 4 Can perform with a lot of human assistance, 5 cannot perform without human assistance. The measure is a dummy variable yes = have 3 or more ADLs each with a score of three or more indicating the need for human assistance. Breathing is scored 1 independent, 5 cannot perform without human assistance, 6 paramedical services needed. The measure is the presence/absence of a breathing item with a score of five or more. Number of persons in household, including other IHSS recipients, excludes non-IHSS children <age 14. HCC refers to Hierarchical Condition Classification, collapsed into 23 subgroups, count is unduplicated number of these groupings. Reference is Non-Relative provider, “na” means the provider type was not included in the model.

TABLE F-5: Logarithm Transformed Mean Monthly Medicaid-Paid Nursing Home Expenditures by IHSS Recipients, 2005 (Excludes Recipients in Managed Care)
Recipients	All Ages			Age 3-17			Age 18-64			Age 65 or More
Recipients	n	Mean	Std Dev	n	Mean	Std Dev	n	Mean	Std Dev	n	Mean	Std Dev
All Recipients	16192			34			3167			12991
Grand Total		12209	15930		45102	66090		12292	17390		12103	15121
Mean $/months		3625	8691		16890	45835		3245	7469		3683	8643
Spouse	469			na			166			303
Mean Total $		10273	16012		na	na		10574	16089		10108	15993
Mean $/month		2848	7610		na	na		2785	8921		2882	6801
Parent	276			26			250			na
Mean Total $		19421	32711		43702	70460		16896	24806		na	na
Mean $/month		5266	17709		17392	50365		4004	8643		na	na
Other Relative	6497			3			934			5560
Mean Total $		11854	15162		26480	12769		11822	15959		11851	15024
Mean $/month		3245	7908		4195	2505		2783	6244		3322	8154
Non-Relative	8950			5			1817			7128
Mean Total $		12346	15622		63558	65007		12057	16887		12384	15150
Mean $/month		3891	8849		21897	36348		3420	7715		3999	9061
Continuing Recipients	14305			32			2663			11610
Total		12714	16411		47273	67530		12991	18189		12555	15507
Mean $/months		3729	8923		17853	47117		3297	7685		3789	8833
Spouse	402			na			146			256
Mean Total $		10796	16864		na	na		10933	16808		10718	16928
Mean $/month		2968	8065		na	na		2928	9471		2991	7160
Parent	245			25			220			na
Mean Total $		20823	33896		45443	71340		18025	25402		na	na
Mean $/month		5589	18658		18086	51277		4169	8937		na	na
Other Relative	5770			3			788			4979
Mean Total $		12266	15507		26480	12769		12402	16504		12236	15344
Mean $/month		3352	8023		4195	2505		2863	6444		3429	8245
Non-Relative	7888			4			1509			6375
Mean Total $		12888	16129		74305	69747		12764	17795		12879	15567
Mean $/month		3985	9106		26636	40147		3432	7882		4102	9313
New IHSS Recipients	1887			2			504			1381
Total		8381	10918		10374	14423		8598	11675		8299	10632
Mean $/months		2839	6625		1491	2047		2972	6204		2792	6778
Spouse	67			na			20			47
Mean Total $		7130	8853		na	na		7948	9157		6782	8798
Mean $/month		2126	3852		na	na		1743	2320		2288	4356
Parent	31			1			30			na
Mean Total $		8342	17921		175	--		8614	18162		na	na
Mean $/month		2706	5972		44	--		2794	6053		na	na
Other Relative	727			--			146			581
Mean Total $		8583	11575			--		8693	12190		8555	11426
Mean $/month		2396	6877			--		2351	5025		2407	7272
Non-Relative	1062			1			308			753
Mean Total $		8324	10301		20572	--		8594	10806		8197	10089
Mean $/month		3191	6590		2939	--		3364	6848		3121	6489
SOURCE: Derived from California Department of Health Care Services, Medicaid claims with vendor codes of 47 (ICF-DD) or 80 (nursing facility) indicating nursing home inpatient claims.

NOTES

If a recipient had “L” (leave of absence, n=599) or an “I” (interim eligible, n=72) status in all listed months in 2005, they were not eligible for inclusion.
Several decision rules were adopted to address persons with multiple providers in any month or who changed provider types during the year: (i) If any individual appears in the Parent/Spouse group for any month in the year, they were classified as in the Parent/Spouse group, regardless of any other combination of providers. This corresponds to the assumption of “an intention to treat.” (ii) If the recipient-provider relationship is missing in all eligible months they were classified into the Non-Relative group. (iii) If an individual appears in a combination of Other Relative and Non-Relative groups during the year, they are classified as in the Other Relative group. This again assumes an intention to treat. (iv) If an individual has a combination of Other Relatives (e.g., minor/adult child, or Other Relatives) during the year, they are classified as having an Other Relative provider. If they had multiple Non-Relative providers in the year, they were classified in the Non-Relative provider group.
Additional county-level attributes were considered and tested in earlier analyses. These included alternative long-term care service supply measures like nursing homes, ICF-MR, adult care facilities, residential care facilities for the elderly; proxy measures for personal assistance labor supply like the per capita number of racial/ethnic minorities, and proxy measures for service demand like the per capita number of aged. These measures are associated with IHSS participation in counties, but they do have consistent associations with the choice of provider types for recipients in the IHSS program itself. For this reason they have not been used in the final models.

Main Report: http://aspe.hhs.gov/daltcp/reports/2008/IHSSPlus.htm

Appendices: http://aspe.hhs.gov/daltcp/reports/2008/IHSSPlus2.htm

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