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

07/01/2008

In addition to unskilled home care, IHSS recipients may receive home health care (a home-based service either provided by a nurse or other licensed professional and/or under their supervision). Generally, this service is for a limited duration, such as following a hospital stay, or as an adjunct to outpatient physical therapy. Among the adult IHSS recipients, home health care utilization follows this expected pattern. There were relatively few such recipients in 2005 (0.3% of the aged, 3.6% non-aged adults). Home health care services are used by somewhat more minor children (8%), and with substantially higher average monthly expenditures (more than $5,000 across all provider groups) than adult recipients. Some of the difference in expenditures between adults and children may be that Medicaid is the primary payer for services to children, while large percentages of these costs may be covered by Medicare or other payers among adults. As shown in Table 28, within both children and aged recipient groups, there was little difference in average monthly Medicaid expenditures between provider groups. Among non-aged adults this pattern changed. Parent providers had substantially higher (about $700 higher) average monthly Medicaid unadjusted expenditures than recipients having non-Parent IHSS providers. Analyses incorporating Medicare expenditures, may alter these findings, but such data were not available to this project.

Differences among provider types in home health care expenditures, adjusting for recipient characteristics, were evaluated using ordinary least squares regression. Each model (not shown) used the same measures as in the earlier OLS regression. Among children and aged IHSS recipients none of the coefficients for provider type or its interaction with the number of health conditions were statistically significant in comparison to non-relatives. Among recipients age 18-64, only Other Relatives differed ($240 lower) from non-relatives. Adult recipients entering IHSS in 2005, tended to have marginally higher average monthly Medicaid-reimbursed home health expenditures among users than continuing recipients (about $940 for non-aged adults, $780 for those age 65+).

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