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


The analytic interest is in understanding who the IHSS Plus Waiver provisions serve, and in evaluating program and recipient outcomes. Analyses are stratified by three age subgroups of IHSS recipients. Within these age groups comparisons are among those with Parent, Spouse, Other Relatives, and Non-Relative as paid caregivers. Comparisons also include recipients in IHSS during 2004 who continued in the program in 2005 and those recipients newly enrolling in the IHSS in 2005. Outcomes are represented by IHSS and Medicaid health, nursing home, and community service use and expenditures. Utilization and expenditures are standardized by average monthly expenditures (based on the recipient’s exposure months in the calendar year). The Behavioral model (Aday & Anderson, 1974) was used to conceptually organize the selection of predictor and control measures.

Y = f(Predisposing: recipient age, gender, race/ethnicity; Enabling: household size, provider relationship, authorized IHSS hours; Need: cognitive status, ADL limitations; breathing limitations; chronic conditions; Service Supply: Per capita income.)

Where Y is separately

Total Medicaid Expenditures, hospital days/stays, nursing home days/stays, ER visits; IHSS expenditures; other Medi-Cal paid home care/personal care long-term care; “avoidable” hospital stays.

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