Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Appendix F. Home Care and Nursing Home Expenditures and Use

07/01/2008

TABLE F-1 Unadjusted Probability of Medicaid-Paid Nursing Home Stays, 2005
(Excludes IHSS Recipients in Managed Care)
Provider Type Any Nursing Home Stays
No Yes Total % Yes
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).
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%

 

TABLE F-2: Adjusted Medicaid-Paid Nursing Home Use by Adult IHSS Recipients, 2005a
(Excludes IHSS Recipients in Managed Care)
Predictors Age 18-64
n=123,813
Age 65 or More
n=206,579
  Odds Ratio   95% CI   Odds Ratio   95% CI
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.
  1. Sample includes all eligible IHSS recipients, excluding those in managed care for one month or more in 2005.
  2. Reference is White.
  3. 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.
  4. 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.
  5. 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.
  6. HCC refers to Hierarchical Condition Classification, collapsed into 23 subgroups, count is unduplicated number of these groupings.
  7. Reference is Non-Relative provider, “na” means the provider type was not included in the model.
Intercept        
Recipient Characteristics
Female Recipient 0.71   0.66-0.76   0.99   0.95-1.03  
Hispanicb 0.90 0.82-1.00 0.88 0.84-0.92
Blackb 1.01 0.92-1.10 1.18 1.12-1.25
Asian/Otherb 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 Limitationsc 0.46 0.37-0.57 1.15 1.03-1.28
3+ ADL Limitationsd 1.42 1.30-1.56 1.34 1.28-1.40
Respiratory Limitationse 0.95 0.84-1.08 1.02 0.95-1.09
Number Health Conditionsf   1.26 1.25-1.27 1.27 1.26-1.28
Provider Relationshipg        
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  

 

TABLE F-3: Logarithm Transformed Mean Medicaid-Paid Monthly HCBS Waiver Expenditures by IHSS Recipients, 2005a
Predictors Provider Relationship
Age 3-17g
n=50
Age 18-64
n=5,258
Age 65+
n=35,205
B   Pr > |t|   B   Pr > |t|   B   Pr > |t|  
* 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).
  1. 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.
  2. Reference is White.
  3. 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.
  4. 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.
  5. 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.
  6. Number of persons in household, including other IHSS recipients, excludes non-IHSS children <age 14.
  7. HCC refers to Hierarchical Condition Classification, collapsed into 23 subgroups, count is unduplicated number of these groupings.
  8. Reference is Non-Relative provider, “na” means the provider type was not included in the model.
Intercept   4.877   *   5.903   ****   6.077   ****
Recipient Characteristicsb
Female Recipient 0.477   -0.110 * -0.064 ****
Hispanic 0.281   -0.066   -0.316 ****
Blacka 0.885   -0.071   -0.304 ****
Asian/Other -1.399   0.147   -0.060 ****
3+ Cognitive Limitationsc   -0.492   0.124   0.059  
3+ ADL Limitationsd -1.357   0.154 ** 0.112 ****
Respiratory Limitationse -1.626 * 0.793 **** -0.133 ****
Household size (1-5+)f 0.334   0.014   0.014 *
Sum HCCsg 0.099   -0.040 **** -0.025 ****
IHSS Providersh
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 ****

 

TABLE F-4: Logarithm Transformed Mean Monthly Medicaid-Paid IHSS Expenditures by IHSS Recipients, 2005a
Predictors Age 3-17g
n=3,936
Age 18-64
n=114,626
Age 65+
n=198,593
B   Pr > |t|   B   Pr > |t|   B   Pr > |t|  
* 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).
  1. 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.
  2. Reference is White.
  3. 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.
  4. 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.
  5. 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.
  6. Number of persons in household, including other IHSS recipients, excludes non-IHSS children <age 14.
  7. HCC refers to Hierarchical Condition Classification, collapsed into 23 subgroups, count is unduplicated number of these groupings.
  8. Reference is Non-Relative provider, “na” means the provider type was not included in the model.
Intercept   4.938   ****   5.021   ****   4.993   ****
Recipient Characteristicsb
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 Limitationsc   -0.274 **** -0.497 **** -0.690 ****
3+ ADL Limitationsd 0.424 **** 0.259 **** 0.209 ****
Respiratory Limitationse 0.101 ** 0.040 **** -0.022 ****
Household size (1-5+)f -0.018   -0.021 **** -0.012 ****
Sum HCCsg 0.012   0.001   -0.003 ****
IHSS Providersh
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 ****

 

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
n Mean   Std Dev   n Mean   Std Dev   n Mean   Std Dev   n Mean   Std Dev  
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.
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

 

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