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

07/01/2008

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TABLE 1: Share of Cost, Advance Pay, Meals Allowance Participation by IHSS Recipient Age, Provider Relationship, & Program Entry Statusa

Eligible IHSS Recipients Spouse Parent Other Relative Non-Relative Total
n % n % n % n % n %
Age 3-17 from 2004 na na 9,798 72.6 1,701 12.6 2,006 14.9 13,505 100.0
Share of Cost na na 143 1.5 8 0.5 4 0.2 155 1.1
   Mean Months if Yes na na 8.1   9.0   7.5   8.1  
Advance Pay na na 34 0.3 12 0.7 7 0.3 53 0.4
   Mean Months if Yes na na 9.5   8.3   12.0   9.5  
Meals Allowance na na 2 0.02 1 0.06 - - 3 0.02
   Mean Months if Yes na na 10.5   12.0   - - 11.0  
Age 3-17, new in 2005 na na 1,780 64.7 389 14.1 583 21.2 2,752 100.0
Share of Cost na na 10 0.6 1 0.3 3 0.5 14 0.5
   Mean Months if Yes na na 6.1   1.0   3.3   5.1  
Advance Pay na na 1 0.06 1 0.3 - - 2 0.07
   Mean Months if Yes na na 9.0   3.0   - - 6.0  
Meals Allowance na na - - - - - - - -
   Mean Months if Yes na na - - - - - - - -
Age 18-64 from 2004   7,121   5.6   21,008     16.7     39,932     31.7     58,057     46.0     126,118     100.0  
Share of Cost 741   10.4   392 1.9 879 2.2 1,567 2.7 3,579 2.8
   Mean Months if Yes 8.9   9.7   8.9   8.9   9.0  
Advance Pay 27 0.4 138 0.7 37 0.1 272 0.5 474 0.4
   Mean Months if Yes 10.6   10.7   9.9   10.4   10.4  
Meals Allowance 6 0.08 13 0.06 47 0.1 278 0.5 344 0.3
   Mean Months if Yes 7.8   10.2   9.7   9.9   9.8  
Age 18-64 new 2005 1,597 6.0 2,484 9.4 9,475 35.8 12,917 48.8 26,473 100.0
Share of Cost 148 9.3 45 1.8 281 3.0 439 3.4 913 3.4
   Mean Months if Yes 4.8   5.9   5.3   4.6   4.9  
Advance Pay 1 0.06 3 0.1 1 0.01 7 0.05 12 0.05
   Mean Months if Yes 12.0   3.7   4.0   5.7   5.6  
Meals Allowance 1 0.06 1 0.04 3 0.03 33 0.3 38 0.14
   Mean Months if Yes 2.0   7.0   9.0   4.7   5.1  
Age 65+ from 2004 4,373 2.2 na na 103,990 52.4 90,160 45.4 198,523 100.0
Share of Cost 507 11.6 na na 3,061 2.9 2,970 3.3 6,538 3.3
   Mean Months if Yes 8.7   na na 9.0   8.6   8.8  
Advance Pay 7 0.16 na na 25 0.02 66 0.07 98 0.05
   Mean Months if Yes 8.6   na na 10.8   8.7   9.2  
Meals Allowance 3 0.07 na na 113 0.11 434 0.5 550 0.3
   Mean Months if Yes 6.7   na na 9.5   9.9   9.8  
Age 65+ new 2005 1,016 2.9 na na 19,506 55.2 14,811 41.9 35,333 100.0
Share of Cost 94 9.3 na na 974 5.0 923 6.2 1,991 5.6
   Mean Months if Yes 5.4   na na 5.5   4.4   5.0  
Advance Pay - - na na 2 0.01 4 0.03 6 0.02
   Mean Months if Yes - - na na 1.0   3.3   2.5  
Meals Allowance - - na na 23 0.12 36 0.24 59 0.17
   Mean Months if Yes - - na na 4.8   4.6   4.7  
Total 14,107   35,070   174,993   178,543   402,704  

SOURCE: California Department of Social Services, unpublished CMIPS data for 2004 and 2005. “na” is not applicable.

  1. Classification into Provider Type was done using the principle of “intention to treat.” Ever having a Spouse provider for one month or in 2005 defined one in this group. Similarly, ever having a Parent provider (but no Spouse provider), or an Other Relative (i.e., but no Spouse or Parent) for at least one month defined one in these respective groups. Non-Relatives had no family members as providers during the year.

TABLE 2: Consistency of Provider Relationships

Provider Relationship Age 3-17 Age 18-64 Age 65+
All   Inconsistent   All   Inconsistent   All   Inconsistent  
2005 n n % n n % n n %
Spouse na na na 8,718 821 9.4 5,389 501 9.3
Parent   11,578     481     4.2   23,492 1,763 7.5 na na na
Other Relative 2,090 98 4.7 49,407 3,601 7.3 123,496 4,671 3.8
Non-Relativea 2,589 124 4.8 70,974 4,135 5.8 104,971 6,776 6.5
Total Inconsistent Relationships   703 4.3     10,320     6.8       11,948     5.1  
Total All (Consistent, & Inconsistent) Relationships   16,257       152,591         233,856      

SOURCE: California Department of Social Services, unpublished CMIPS data for 2004 and 2005.


TABLE 3: Race/Ethnicity of New & Continuing IHSS Recipients, 2005

  Spouse Parent Other Relative Non-Relative Total
n % n % n % n % n %
Continuing Recipients Age 3-17     9,798   1,701   2,006   13,505  
1 White na na 2,546 26.0 468 27.5 769 38.3 3,783 28.0
2 Hispanic na na 4,951 50.5 568 33.4 568 28.3 6,087 45.1
3 Black na na 1,422 14.5 455 26.7 489 24.4 2,366 17.5
4 Asian & Others na na 879 9.0 210 12.3 180 9.0 1,269 9.4
New Recipients Age 3-17     1,780   389   583   2,752  
1 White na na 489 27.5 83 21.3 225 38.6 797 29.0
2 Hispanic na na 824 46.3 127 32.6 182 31.2 1,133 41.2
3 Black na na 273 15.3 125 32.1 111 19.0 509 18.5
4 Asian & Others na na 194 10.9 54 13.9 65 11.1 313 11.4
Continuing Recipients Age 18-64     7,121       21,008     39,932   58,057     126,118    
1 White 2,434   34.2   8,612   41.0     14,803     37.1     28,183     48.5   54,032   42.8  
2 Hispanic 2,616 36.7 6,967 33.2 8,759 21.9 8,899 15.3 27,241 21.6
3 Black 687 9.6 3,183 15.2 10,771 27.0 17,701 30.5 32,342 25.6
4 Asian & Others 1,384 19.4 2,246 10.7 5,599 14.0 3,274 5.6 12,503 9.9
New Recipients Age 18-64 1,597   2,484   9,475   12,917   26,473  
1 White 500 31.3 941 37.9 3,371 35.6 6,556 50.8 11,368 42.9
2 Hispanic 636 39.8 785 31.6 2,259 23.8 1,966 15.2 5,646 21.3
3 Black 166 10.4 501 20.2 2,637 27.8 3,614 28.0 6,918 26.1
4 Asian & Others 295 18.5 257 10.3 1,208 12.7 781 6.0 2,541 9.6
Continuing Recipients Age 65+   4,373       103,990   90,160   198,523  
1 White 911 20.8 na na 36,448 35.0 41,568 46.1 78,927 39.8
2 Hispanic 1813 41.5 na na 24,800 23.8 19,275 21.4 45,888 23.1
3 Black 201 4.6 na na 9,472 9.1 12,288 13.6 21,961 11.1
4 Asian & Others 1448 33.1 na na 33,270 32.0 17,029 18.9 51,747 26.1
New Recipients Age 65+ 1,016       19,506   14,811   35,333  
1 White 194 19.1 na na 5,182 26.6 6,259 42.3 11,635 32.9
2 Hispanic 435 42.8 na na 5,538 28.4 3,466 23.4 9,439 26.7
3 Black 63 6.2 na na 1,652 8.5 1,480 10.0 3,195 9.0
4 Asian & Others 324 31.9 na na 7,134 36.6 3,606 24.3 11,064 31.3

SOURCE: California Department of Social Services, unpublished CMIPS data for 2005. “na” means that these provider types were not included in the analysis.


TABLE 4: Race/Ethnicity Distribution Among IHSS Provider Groups, 2005

  Spouse Parent Other Relative Non-Relative Total
n % n % n % n % n
Continuing Recipients Age 3-17     9,798   1,701   2,006   13,505
1 White na na 2,546 67.3 468 12.4 769 20.3 3,783
2 Hispanic na na 4,951 81.3 568 9.3 568 9.3 6,087
3 Black na na 1,422 60.1 455 19.2 489 20.7 2,366
4 Asian & Others na na 879 69.3 210 16.5 180 14.2 1,269
New Recipients Age 3-17     1,780   389   583   2,752
1 White na na 489 61.4 83 10.4 225 28.2 797
2 Hispanic na na 824 72.7 127 11.2 182 16.1 1,133
3 Black na na 273 53.6 125 24.6 111 21.8 509
4 Asian & Others na na 194 62.0 54 17.3 65 20.8 313
Continuing Recipients Age 18-64     7,121       21,008     39,932     58,057       126,118  
1 White 2,434 4.5 8,612   15.9   14,803   27.4   28,183   52.2   54,032
2 Hispanic 2,616 9.6 6,967 25.6 8,759 32.2 8,899 32.7 27,241
3 Black 687 2.1 3,183 9.8 10,771 33.3 17,701 54.7 32,342
4 Asian & Others 1,384   11.1   2,246 18.0 5,599 44.8 3,274 26.2 12,503
New Recipients Age 18-64 1,597   2,484   9,475   12,917   26,473
1 White 500 4.4 941 8.3 3,371 29.7 6,556 57.7 11,368
2 Hispanic 636 11.3 785 13.9 2,259 40.0 1,966 34.8 5,646
3 Black 166 2.4 501 7.2 2,637 38.1 3,614 52.2 6,918
4 Asian & Others 295 11.6 257 10.1 1,208 47.5 781 30.7 2,541
Continuing Recipients Age 65+ 4,373         103,990     90,160   198,523
1 White 911 1.2 na na 36,448 46.2 41,568 52.7 78,927
2 Hispanic 1813 4.0 na na 24,800 54.0 19,275 42.0 45,888
3 Black 201 0.9 na na 9,472 43.1 12,288 56.0 21,961
4 Asian & Others 1448 2.8 na na 33,270 64.3 17,029 32.9 51,747
New Recipients Age 65+ 1,016       19,506   14,811   35,333
1 White 194 1.7 na na 5,182 44.5 6,259 53.8 11,635
2 Hispanic 435 4.6 na na 5,538 58.7 3,466 36.7 9,439
3 Black 63 2.0 na na 1,652 51.7 1,480 46.3 3,195
4 Asian & Others 324 2.9 na na 7,134 64.5 3,606 32.6 11,064

SOURCE: California Department of Social Services, unpublished CMIPS data for 2005. “na” means that these provider types were not included in the analysis.


TABLE 5a: Selected Household Characteristics of IHSS Recipients, Age 3-17

IHSS Recipients Parent Other Relative Non-Relative Total
n % n % n % n %
Continuing from 2004   9798       1701       2006       13505    
  Female 3808   38.9   647   38.0   784   39.1   5239   38.8  
Household size
  1 15 0.2 8 0.5 16 0.8 39 0.3
  2 1051 10.7 192 11.3 274 13.7 1517 11.2
  3 2157 22.0 364 21.4 470 23.4 2991 22.2
  4 2502 25.5 428 25.2 544 27.1 3474 25.7
  5+ 4073 41.6 709 41.7 702 35.0 5484 40.6
Parent Presenta
  No Parent Present 396 4.0 520 30.6 377 18.8 1293 9.6
  Provides All Services 8138 83.1 251 14.8 578 28.8 8967 66.4
  Provides Some Services   1129 11.5 481 28.3 517 25.8 2127 15.7
  Provides No Services 113 1.2 313 18.4 304 15.2 730 5.4
  Parent IHSS Recipient 22 0.2 136 8.0 230 11.5 388 2.9
Housing
  House 5493 56.1 1144 67.3 1339 66.7 7976 59.1
  Apartment 3861 39.4 492 28.9 594 29.6 4947 36.6
  Mobile Home 316 3.2 47 2.8 53 2.6 416 3.1
  Hotel/Other 128 1.3 18 1.1 20 1.0 166 1.2
Entering IHSS in 2005 1,780   389   583   2752  
  Female 705 39.6 150 38.6 212 36.4 1067 38.8
Household Size
  1 2 0.1 0 0.0 3 0.5 5 0.2
  2 179 10.1 35 9.0 71 12.2 285 10.4
  3 330 18.5 82 21.1 158 27.1 570 20.7
  4 499 28.0 93 23.9 158 27.1 750 27.3
  5+ 770 43.3 179 46.0 193 33.1 1142 41.5
Parent Presenta
  No Parent Present 0 0.0 108 27.8 107 18.4 341 12.4
  Provides All Services 1426 80.1 49 12.6 190 32.6 1665 60.5
  Provides Some Services 203 11.4 121 31.1 150 25.7 474 17.2
  Provides No Services 145 8.1 70 18.0 92 15.8 181 6.6
  Parent IHSS Recipient 6 0.3 41 10.5 44 7.5 91 3.3
Housing
  House 966 54.3 229 58.9 376 64.5 1571 57.1
  Apartment 715 40.2 144 37.0 179 30.7 1038 37.7
  Mobile Home 64 3.6 9 2.3 18 3.1 91 3.3
  Hotel/Other 35 2.0 7 1.8 10 1.7 52 1.9

SOURCE: California Department of Social Services, unpublished CMIPS data for 2005.

  1. May not total to 100% due to missing values, “na” not applicable, “unk” unknown.]

TABLE 5b: Selected Household Characteristics of IHSS Recipients, Age 18-64

IHSS Recipients Spouse Parent   Other Relative   Non-Relative Total
n % n % n % n % n %
Continuing from 2004 7121     21008     39932   58057     126118    
  Female   2407     33.8   9494   45.2     27676     69.3     34944     60.2   74521   59.1  
Household size
  1 120 1.7 1336 6.4 7548 18.9 22800 39.3 31804 25.2
  2 2596 36.5 5418 25.8 13093 32.8 20877 36.0 41984 33.3
  3 1598 22.4 6457 30.7 7916 19.8 7347 12.7 23318 18.5
  4 1253 17.6 3792 18.1 4817 12.1 3548 6.1 13410 10.6
  5+ 1554 21.8 4005 19.1 6558 16.4 3485 6.0 15602 12.4
Spouse Presenta
  No Spouse na   19298 91.9 31009 77.7 52607 90.6 102914 81.6
  Spouse Able/Available 6145 86.3 73 0.3 1431 3.6 1221 2.1 8870 7.0
  Spouse Availability Limited 400 5.6 75 0.4 786 2.0 558 1.0 1819 1.4
  Spouse Not Able 537 7.5 17 0.1 1179 3.0 703 1.2 2436 1.9
  Spouse is IHSS Recipient 22 0.3 54 0.3 5291 13.3 2633 4.5 8000 6.3
Parent Presenta
  No Parent Present unk   na   unk   unk   unk  
  Provides Some Services 16 0.2 1448 6.9 94 0.2 193 0.3 1751 1.4
  Provides No Services     32 0.2 27 0.1 48 0.1 107 0.1
  Parent is IHSS Recipient 1 0.0 11 0.1 115 0.3 94 0.2 221 0.2
Housing
  House 3810 53.5 14401 68.6 19095 47.8 22210 38.3 59516 47.2
  Apartment 2687 37.7 5565 26.5 18896 47.3 31070 53.5 58218 46.2
  Mobile Home 484 6.8 830 4.0 1427 3.6 3498 6.0 6239 4.9
  Hotel/Other 140 2.0 212 1.0 514 1.3 1279 2.2 2145 1.7
Entering IHSS in 2005 1597   2484   9475   12917   26473  
  Female 506 31.7 1022 41.1 6386 67.4 7273 56.3 15187 57.4
Household size
  1 31 1.9 172 6.9 1653 17.4 4989 38.6 6845 25.9
  2 557 34.9 534 21.5 2748 29.0 4118 31.9 7957 30.1
  3 342 21.4 704 28.3 1950 20.6 1851 14.3 4847 18.3
  4 259 16.2 492 19.8 1293 13.6 933 7.2 2977 11.2
  5+ 408 25.5 582 23.4 1831 19.3 1026 7.9 3847 14.5
Spouse Presenta
  No Spouse na na 2303 92.7 7273 76.8 11723 90.8 21299 80.5
  Spouse Able/Available 1441 90.2 19 0.8 465 4.9 417 3.2 2342 8.8
  Spouse Availability Limited 52 3.3 7 0.3 229 2.4 112 0.9 400 1.5
  Spouse Not Able 88 5.5 4 0.2 335 3.5 197 1.5 624 2.1
  Spouse is IHSS Recipient 7 0.4 5 0.2 1143 12.1 430 3.3 1585 6.0
Parent Presenta
  No Parent Present unk   na   unk   unk   unk  
  Provides Some Services 8 0.5 145 5.8 13 0.1 22 0.2 188 0.7
  Parent is IHSS Recipient 1 0.1 1 0.0 12 0.1 8 0.1 22 0.1
Housing
  House 845 52.9 1613 64.9 4356 46.0 4776 37.0 11590 43.8
  Apartment 596 37.3 713 28.7 4589 48.4 6679 51.7 12577 47.5
  Mobile Home 119 7.5 116 4.7 367 3.9 936 7.2 1538 5.8
  Hotel/Other 37 2.3 42 1.7 163 1.7 526 4.1 768 2.9

SOURCE: California Department of Social Services, unpublished CMIPS data for 2005

  1. May not total to 100% due to missing items, “na” not applicable, “unk” unknown.

TABLE 5c: Selected Household Characteristics of IHSS Recipients, Age 65+

IHSS Recipients Parent Other Relative Non-Relative Total
n % n % n % n %
Continuing from 2004   4373       103990       90160       198523    
  Female 836   19.1   74883   72.0   64223   71.2   139942   70.5  
Household Size
  1 85 1.9 20271 19.5 41840 46.4 62196 31.3
  2 2343 53.6 34892 33.6 31463 34.9 68698 34.6
  3 722 16.5 17182 16.5 7387 8.2 25291 12.7
  4 465 10.6 11006 10.6 3840 4.3 15311 7.7
  5+ 758 17.3 20639 19.8 5630 6.2 27027 13.6
Spouse Presenta
  No Spouse Present na   70564 67.9 69419 77.0 139983 70.5
  Spouse Able/Available 3881 88.7 1801 1.7 1053 1.2 6735 3.4
  Spouse Availability Limited 156 3.6 300 0.3 225 0.2 681 0.3
  Spouse Not Able 286 6.5 2962 2.8 1831 2.0 5079 2.6
  Spouse is IHSS Recipient 45 1.0 28317 27.2 17602 19.5 45964 23.2
Parent Presenta
  Parent Present unk   unk   unk   unk  
  Provides Some Services     2 <0.00 3 <0.00 5 <0.00
  Parent is IHSS Recipient     35 0.03 22 0.02 57 0.05
Housing
  House 2288 52.3 53719 51.7 30116 33.4 86123 43.4
  Apartment 1731 39.6 45445 43.7 54323 60.3 101499 51.1
  Mobile Home 283 6.5 3123 3.0 4343 4.8 7749 3.9
  Hotel/Other 71 1.6 1703 1.6 1378 1.5 3152 1.6
# Entering in 2005 1016   19506   14811   35333  
  Female 174 17.1 13605 69.7 9855 66.5 23634 66.9
Household Size
  1 14 1.4 3161 16.2 6596 44.5 9771 27.7
  2 533 52.5 5658 29.0 4735 32.0 10926 30.9
  3 171 16.8 3534 18.1 1447 9.8 5152 14.6
  4 94 9.2 2440 12.5 794 5.4 3328 9.4
  5+ 204 20.1 4713 24.2 1239 8.4 6156 17.4
Spouse Presenta
  No Spouse Present na   13073 67.0 11398 77.0 24471 69.3
  Spouse Able/Available 933 91.8 561 2.9 430 2.9 1924 5.4
  Spouse Availability Limited 19 1.9 86 0.4 73 0.5 178 0.5
  Spouse Not Able 8 0.8 698 3.6 457 3.1 1163 3.0
  Spouse is IHSS Recipient 10 1.0 5067 26.0 2441 16.5 7518 21.3
Parent Present a
  Parent Present unk   unk   unk   unk  
  Provides Some Services 2 0.2 7 0.04 9 0.06 18 0.05
  Parent is IHSS Recipient 1 0.1 12 0.06 3 0.02 16 0.05
Housing
  House 510 50.2 11013 56.5 5541 37.4 17064 48.3
  Apartment 422 41.5 7348 37.7 7871 53.1 15641 44.3
  Mobile Home 61 6.0 757 3.9 1051 7.1 1869 5.3
  Hotel/Other 23 2.3 388 2.0 348 2.3 759 2.1

SOURCE:: California Department of Social Services, unpublished CMIPS data for 2005.

  1. May not total to 100% due to missing values, “na” not applicable, “unk” unknown.

TABLE 6: Physical & Cognitive Limitations Among New & Continuing IHSS Recipients, 2005

  Spouse Parent Other Relative Non-Relative Total
n n n n n
Continuing Recipients Age 3-17   9,798 1,701 2,006 13,505
  Average Total Authorized IHSS Hours   112.3 102.3 107.8 110.4
  Mean Number Cognitive Limitationsa   0.6 0.5 0.6 0.6
  Mean Number ADL Limitationsb   3.6 3.5 3.6 3.6
  Mean Number IADL Limitationsc   3.1 3.4 3.3 3.2
  % with Breathing Limitationd   16.2 14.8 12.3 15.4
New Recipients Age 3-17   1,780 389 583 2,752
  Average Total Authorized IHSS Hours   70.1 61.4 69.2 68.7
  Mean Number Cognitive Limitationsa   0.4 0.4 0.4 0.4
  Mean Number ADL Limitationsb   3.3 3.0 3.2 3.2
  Mean Number IADL Limitationsc   2.9 3.3 3.0 3.0
  % with Breathing Limitationd   9.3 9.3 11.5 9.8
Continuing Recipients Age 18-64   7,121     21,008     39,932     58,057     126,118  
  Average Total Authorized IHSS Hours 86.3 134.6 79.6 89.2 93.6
  Mean Number Cognitive Limitationsa 0.1 0.7 0.1 0.1 0.2
  Mean Number ADL Limitationsb 3.7 3.1 2.5 2.3 2.6
  Mean Number IADL Limitationsc 4.6 4.3 4.3 4.3 4.3
  % with Breathing Limitationd 11.1 7.2 6.6 7.5 7.4
New Recipients Age 18-64 1,597 2,484 9,475 12,917 26,473
  Average Total Authorized IHSS Hours 61.4 79.3 57.4 57.2 59.6
  Mean Number Cognitive Limitationsa 0.04 0.3 0.05 0.04 0.1
  Mean Number ADL Limitationsb 3.5 2.4 2.1 1.8 2.1
  Mean Number IADL Limitationsc 4.4 4.2 4.3 4.1 4.2
  % with Breathing Limitationd 8.1 4.0 4.5 5.1 5.0
Continuing Recipients Age 65+ 4,373     103,990   90,160 198,523
  Average Total Authorized IHSS Hours 83.4   82.5 85.8 84.0
  Mean Number Cognitive Limitationsa 0.1   0.1 0.1 0.1
  Mean Number ADL Limitationsb 3.9   2.8 2.5 2.7
  Mean Number IADL Limitationsc 4.6   4.5 4.4 4.5
  % with Breathing Limitationd 11.0   6.2 6.2 6.3
New Recipients Age 65+ 1,016   19,506 14,811 35,333
  Average Total Authorized IHSS Hours 58.6   61.2 58.9 60.2
  Mean Number Cognitive Limitationsa 0.1   0.1 0.05 0.1
  Mean Number ADL Limitationsb 3.6   2.4 1.9 2.2
  Mean Number IADL Limitationsc 4.4   4.4 4.2 4.3
  % with Breathing Limitationd 10.0   4.5 4.5 4.6

SOURCE: California Department of Social Services, unpublished CMIPS data for 2005

  1. Number of tasks cannot perform memory, orientation, or judgment tasks without human assistance.
  2. Number of tasks cannot perform ADLs (i.e., bathing and grooming; dressing; transferring; bowel, bladder and menstrual care; eating) without human assistance.
  3. Number of tasks cannot perform IADLs (i.e., housework, laundry, shopping and errands, meal preparation and clean-up, mobility inside) without human assistance.
  4. Cannot breathe without human assistance.

TABLE 7: Limitations Among Meals Allowance & Advance Pay IHSS Waiver Recipients, 2005

Age Group Meals Allowance Advance Pay
3-17 18-64 65+ 3-17 18-64 65+
IHSS Plus Recipients N=3   N=382     N=609     N=55     N=486     N=104  
ADL Limitationsa
  % 3 or more 66.7 27.2 31.4 96.4 97.9 100.0
IADL Limitationsb
  % 3 or more 100.0 95.5 98.7 72.7 100.0 100.0
Cognitive Limitationsc
  % 0 66.7 98.4 98.9 54.5 83.7 83.7
  % 2 or more 33.3 1.3 0.8 36.4 14.0 13.5
Breathing Problemsd
  % 0   100.0   94.8 94.3   69.1   78.0 75.0

SOURCE: California Department of Social Services, unpublished CMIPS data for 2005

  1. Number of tasks cannot perform assistance in ADLs (i.e., bathing and grooming; dressing; transferring; bowel, bladder and menstrual care; eating) without human assistance.
  2. Number of tasks cannot perform IADLs (i.e., housework, laundry, shopping and errands, meal preparation and clean-up, mobility inside) without at least direct physical human assistance.
  3. Number of tasks cannot perform memory, orientation, or judgment tasks without human assistance.
  4. Cannot breathe without human assistance.

TABLE 8: Modal Hourly IHSS Wage Rate, by County, 2003

County   Hourly Wage Rate   County   Hourly Wage Rate  
ALAMEDA 9.50 ORANGE 8.00
ALPINE 7.11 PLACER 6.75
AMADOR 6.95 PLUMAS 7.11
BUTTE 7.11 RIVERSIDE 7.11
CALAVERAS 6.75 SACRAMENTO 9.50
COLUSA 6.75 SAN BENITO 6.75
CONTRA COSTA   9.50 SAN BERNARDINO   8.50
DEL NORTE 6.75 SAN DIEGO 8.50
EL DORADO 6.75 SAN FRANCISCO 10.10
FRESNO 7.50 SAN JOAQUIN 8.50
GLENN 7.11 SAN LUIS OBISPO 6.95
HUMBOLDT 6.75 SAN MATEO 9.50
IMPERIAL 6.75 SANTA BARBARA 7.11
INYO 6.75 SANTA CLARA 10.50
KERN 6.75 SANTA CRUZ 9.50
KINGS 6.75 SHASTA 6.75
LAKE 6.75 SIERRA 7.11
LASSEN 6.75 SISKIYOU 6.75
LOS ANGELES 7.50 SOLANO 9.50
MADERA 6.75 SONOMA 9.50
MARIN 9.75 STANISLAUS 6.95
MARIPOSA 6.75 SUTTER 6.75
MENDOCINO 7.11 TEHAMA 6.75
MERCED 6.95 TRINITY 6.75
MODOC 6.75 TULARE 6.75
MONO 7.11 TUOLUMNE 6.75
MONTEREY 9.50 VENTURA 7.11
NAPA 8.50 YOLO 9.60
NEVADA 7.11 YUBA 6.75

SOURCE: Derived from unpublished CMIPS recorded payments to IHSS recipients in 2003


TABLE 9: Number of Chronic Health Conditions by Medicaid Recipient Age Comparing New and Continuing IHSS Recipient, 2005

IHSS Recipient Age Group   # IHSS Recipients, 2005     Mean # HCC’s     Standard Deviation  
Total Recipients, 2005 346,552 3.41 2.82
  3-17 11,583 3.37 2.97
  18-64 125,502 4.21 3.25
  65 or more 209,467 2.93 2.40
Recipients Continuing from 2004   293,459 3.35 2.77
  3-17 9,914 3.43 2.96
  18-64 104,786 4.09 3.20
  65 or more 178,759 2.91 2.36
New IHSS Recipients 2005 53,093 3.71 3.09
  3-17 1,669 3.01 3.05
  18-64 20,716 4.78 3.44
  65 or more 30,708 3.03 2.60

SOURCE: California Department of Health Care Services, Medicaid claims for 2005. HCC refers to Hierarchical Condition Classifications (Pope, Ellis, Ash, et al., 2000). Recipient counts are limited to IHSS recipients not enrolled in Medicaid managed care at anytime in 2005, but includes any claims in 2005 regardless of the IHSS eligibility period.


TABLE 10a: Summary of Health Conditions Among IHSS Recipients Age 3-17 by Provider Group, 2005

  Parent Other Relative Non-Relative
  Number   %   Number   %   Number   %
Total Recipients 8,293   100.0   1,455   100.0   1,835   100.0  
Recipients w/ Any HCCa 6,740 81.3 1,055 72.5 1,261 68.7
Collapsed HCC Groupings
  Infectious and Parasitic Disease 1,055 12.7 156 10.7 171 9.3
  Neoplasms 334 4.0 38 2.6 43 2.3
  Endocrine, Nutritional & Metabolic Disorders 706 8.5 105 7.2 101 5.5
  Liver & Gallbladder Disease 80 1.0 10 0.7 7 0.4
  Gastro-Intestinal Disease 1,583 19.1 218 15.0 216 11.8
  Musculoskeletal/Connective Tissue 1,937 23.4 246 16.9 295 16.1
  Disease of the Blood & Blood Forming Organs 273 3.3 42 2.9 50 2.7
  Mental Disorders 859 10.4 140 9.6 131 7.1
  Mental Retardation/Developmental Disability 1,464 17.7 216 14.8 250 13.6
  Central Nervous System Injuries/Disorders 2,575 31.1 384 26.4 411 22.4
  Respiratory System Disease/Disorders 360 4.3 41 2.8 57 3.1
  Cardiovascular System 664 8.0 79 5.4 77 4.2
  Cerebral & Other Vascular System 1,302 15.7 200 13.7 203 11.1
  Pulmonary System 2,143 25.8 319 21.9 361 19.7
  Eyes & Vision Disorders 1,360 16.4 168 11.5 195 10.6
  Ear, Nose, & Throat Disorders 3,856 46.5 565 38.8 621 33.8
  Renal System 85 1.0 11 0.8 10 0.5
  Other Genitourinary System 924 11.1 142 9.8 136 7.4
  Pregnancy/Child Birth Complications 143 1.7 19 1.3 14 0.8
  Dermatological Disorders 1,218 14.7 186 12.8 190 10.4
  Fractures, Other Injuries, & Poisoning 1,146 13.8 169 11.6 238 13.0
  Treatment Complications, Ill-Defined Conditions   3,621 43.7 534 36.7 584 31.8
  Miscellaneous 2,318 28.0 345 23.7 367 20.0

SOURCE: California Department of Health Care Services, Medicaid claims, 2005. Counts apply to IHSS recipients not in Medicaid Managed for any month in calendar year 2005.

  1. HCC refers to Hierarchical Condition Classifications (Pope, Ellis, Ash, et al., 2000).

TABLE 10b: Summary of Health Conditions Among IHSS Recipients Age 18-64 by Provider Group, 2005

  Spouse Parent Other Relative Non-Relative
  Number   %   Number   %   Number   %   Number   %
Total Recipients 6,721   100.0   18,749   100.0   40,603   100.0   59,429   100.0  
Recipients w/ Any HCCa 6,003 89.3 13,789 73.5 36,362 89.6 52,197 87.8
Collapsed HCC Groupings
  Infectious and Parasitic Disease 791 11.8 1,655 8.8 4,511 11.1 8,006 13.5
  Neoplasms 865 12.9 981 5.2 5,604 13.8 7,643 12.9
  Endocrine, Nutritional & Metabolic Disorders 2,284 34.0 2,559 13.6 13,697 33.7 16,587 27.9
  Liver & Gallbladder Disease 494 7.4 539 2.9 2,594 6.4 4,133 7.0
  Gastro-Intestinal Disease 1,633 24.3 2,479 13.2 9,740 24.0 13,378 22.5
  Musculoskeletal/Connective Tissue 2,814 41.9 3,888 20.7 19,406 47.8 27,639 46.5
  Disease of the Blood & Blood Forming Organs 533 7.9 759 4.0 3,060 7.5 4,071 6.9
  Mental Disorders 741 11.0 1,967 10.5 5,112 12.6 9,425 15.9
  Mental Retardation/ Developmental Disability 19 0.3 1,143 6.1 385 0.9 650 1.1
  Central Nervous System Injuries/Disorders 1,080 16.1 4,025 21.5 5,386 13.3 9,627 16.2
  Respiratory System Disease/Disorders 279 4.2 489 2.6 1,419 3.5 2,093 3.5
  Cardiovascular System 2,548 37.9 2,321 12.4 16,984 41.8 19,959 33.6
  Cerebral & Other Vascular System 1,258 18.7 1,762 9.4 6,200 15.3 8,212 13.8
  Pulmonary System 1,739 25.9 2,804 15.0 10,869 26.8 15,659 26.3
  Eyes & Vision Disorders 1,123 16.7 1,468 7.8 7,991 19.7 8,825 14.8
  Ear, Nose, & Throat Disorders 1,355 20.2 3,899 20.8 8,664 21.3 12,019 20.2
  Renal System 809 12.0 576 3.1 2,813 6.9 2,980 5.0
  Other Genitourinary System 1,363 20.3 2,507 13.4 8,490 20.9 11,768 19.8
  Pregnancy/Child Birth Complications 45 0.7 147 0.8 194 0.5 449 0.8
  Dermatological Disorders 1,159 17.2 2,682 14.3 7,330 18.1 12,025 20.2
  Fractures, Other Injuries, & Poisoning 1,356 20.2 2,549 13.6 7,599 18.7 13,695 23.0
  Treatment Complications, Ill-Defined Conditions   3,778 56.2 6,277 33.5 22,972 56.6 32,156 54.1
  Miscellaneous 2,129 31.7 4,120 22.0 13,819 34.0 20,151 33.9

SOURCE:: California Department of Health Care Services, Medicaid claims, 2005. Counts apply to IHSS recipients not in Medicaid Managed for any month in calendar year 2005.

  1. HCC refers to Hierarchical Condition Classifications (Pope, Ellis, Ash, et al., 2000).

 


TABLE 10c: Summary of Health Conditions Among IHSS Recipients Age 65+ by Provider Group, 2005

  Spouse Other Relative Non-Relative
  Number   %   Number   %   Number   %
Total Recipients 4,656   100.0   109,260   100.0   95,551   100.0  
Recipients w/ Any HCCa 3,847 82.6 91,221 83.5 80,167 83.9
Collapsed HCC Groupings
  Infectious and Parasitic Disease 330 7.1 6,263 5.7 6,593 6.9
  Neoplasms 611 13.1 11,898 10.9 12,085 12.6
  Endocrine, Nutritional & Metabolic Disorders 1,047 22.5 18,517 16.9 15,975 16.7
  Liver & Gallbladder Disease 167 3.6 2,848 2.6 2,347 2.5
  Gastro-Intestinal Disease 812 17.4 16,924 15.5 16,041 16.8
  Musculoskeletal/Connective Tissue 1,246 26.8 34,101 31.2 32,979 34.5
  Disease of the Blood & Blood Forming Organs 270 5.8 5,311 4.9 4,893 5.1
  Mental Disorders 286 6.1 6,369 5.8 6,359 6.7
  Mental Retardation/Developmental Disability 1 0.0 32 0.0 32 0.0
  Central Nervous System Injuries/Disorders 251 5.4 3,604 3.3 3,566 3.7
  Respiratory System Disease/Disorders 149 3.2 1,821 1.7 1,658 1.7
  Cardiovascular System 1,842 39.6 41,481 38.0 36,234 37.9
  Cerebral & Other Vascular System 927 19.9 14,141 12.9 13,436 14.1
  Pulmonary System 936 20.1 18,348 16.8 16,283 17.0
  Eyes & Vision Disorders 662 14.2 18,109 16.6 16,198 17.0
  Ear, Nose, & Throat Disorders 354 7.6 8,407 7.7 7,630 8.0
  Renal System 414 8.9 4,064 3.7 3,045 3.2
  Other Genitourinary System 630 13.5 10,967 10.0 10,573 11.1
  Pregnancy/Child Birth Complications 4 0.1 66 0.1 58 0.1
  Dermatological Disorders 435 9.3 10,408 9.5 12,443 13.0
  Fractures, Other Injuries, & Poisoning 532 11.4 12,159 11.1 12,411 13.0
  Treatment Complications, Ill-Defined Conditions   2,115 45.4 45,290 41.5 41,474 43.4
  Miscellaneous 769 16.5 17,424 15.9 17,536 18.4

SOURCE: California Department of Health Care Services, Medicaid claims, 2005. Counts apply to IHSS recipients not in Medicaid Managed for any month in calendar year 2005.

  1. HCC refers to Hierarchical Condition Classifications (Pope, Ellis, Ash, et al., 2000).

TABLE 11: Mean Medicaid Expendituresa for IHSS Recipients by Observation Months and Age, 2005

  # Months     Variable   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
1 Mean Total $ 7470 6429 21286 161 4952 22513 2737 6130 23623 4572 6660 19708
Average $/month     6429 21286   4952 22513   6130 23623   6660 19708
2 Mean Total $ 8143 7450 30155 156 5837 19420 2898 7912 24204 5089 7237 33315
Average $/month     3725 15078   2918 9710   3956 12102   3618 16657
3 Mean Total $ 8200 8519 33349 177 10462 40166 2943 9847 47735 5080 7682 20437
Average $/month     2840 11116   3487 13389   3283 15912   2561 6812
4 Mean Total $ 7924 9002 24208 187 9838 68754 2923 10424 28450 4864 8115 17077
Average $/month     2251 6052   2459 17189   2606 7112   2029 4269
5 Mean Total $ 8306 9799 26326 202 7215 19105 3088 11552 35135 5016 8824 19237
Average $/month     1960 5265   1443 3821   2310 7027   1765 3847
6 Mean Total $ 7792 10660 26714 215 7862 17845 2901 12913 36594 4676 9391 18409
Average $/month     1777 4452   1310 2974   2152 6099   1565 3068
7 Mean Total $ 8132 11137 25274 213 13057 51298 2958 13326 32396 4961 9749 17438
Average $/month     1591 3611   1865 7328   1904 4628   1393 2491
8 Mean Total $ 7964 11876 27485 211 11094 29938 2982 14251 39098 4771 10426 16145
Average $/month     1485 3436   1387 3742   1781 4887   1303 2018
9 Mean Total $ 8354 12747 30990 249 15776 41906 3139 15247 45601 4966 11016 14363
Average $/month     1416 3443   1753 4656   1694 5067   1224 1596
10 Mean Total $ 10274 13081 23861 322 13644 32412 4046 14329 24634 5906 12196 22713
Average $/month     1308 2386   1364 3241   1433 2463   1220 2271
11 Mean Total $ 12809 14854 28848 450 14279 30923 4905 17383 37615 7454 13224 20849
Average $/month     1350 2623   1298 2811   1580 3420   1202 1895
12 Mean Total $ 245976 12808 16164 8459 14592 32210 88293 14366 21113 149224 11785 10269
Average $/month     1067 1347   1216 2684   1197 1759   982 856
Grand Average Total   341394     12248     20017     11002     13802     33328     123813     13841     25951     206579     11211     14024  
$/month   1405 4872   1394 5030   1570 5522   1306 4425

SOURCE: California Department of Health Care Services, Medicaid claims, 2005

  1. Services included in the compilation of expenditures include personal assistance/home care, home health, inpatient hospital and nursing home care, physicians, clinics, outpatient departments, ancillary providers, physical/occupational/speech therapy, durable medical equipment, vision and hearing services, and mental health services. Excluded are payments for pharmacy products, and expenditure by Medicare, VA, out of pocket, or other payers.

TABLE 12: Mean Medicaid Expendituresa by IHSS Recipient Age and Provider Type, 2005

Variable 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
Total 2005   341,394         11,002         123,813         206,579      
Grand Totalb     12248     20017       13802     33328       13841     25951       11211     14024  
  Mean $/month     1405 4872   1394 5030   1570 5522   1306 4425
Spouse 10,438     na     6282     4156    
  Mean Total $   7206 20109   na     8249 20883   5628 18771
  Mean $/month     954 3789   na     1075 4113   770 3232
Parent 26,410     7,785     18,625     na    
  Mean Total $   15089 28332   12313 33843   16250 25592   na  
  Mean $/month     1491 5010   1260 5400   1588 4835   na  
Other Relative 150,124     1,449     40,304     108,371    
  Mean Total $   11757 18246   18875 31935   13282 24991   11095 14605
  Mean $/month     1321 5031   1759 3196   1482 5534   1256 4850
Non-Relative 154,422     1768     58,602     94,052    
  Mean Total $   12581 19853   16198 31579   14060 27074   11591 13003
  Mean $/month     1502 4752   1686 4519   1679 5837   1388 3927
Continuing 290,000     9,529     103,608     176,863    
Grand Totalb   13275 20282   14878 34672   14883 26079   12247 14443
  Mean $/month     1433 4904   1444 5250   1548 5361   1366 4593
Spouse 8,749     na     5,301     3,448    
  Mean Total $   7482 20921   na na   8448 21493   5996 19922
  Mean $/month     919 3879   na na   1017 4173   769 3372
Parent 23,660     6,883     16,777     na    
  Mean Total $   15894 29049   13201 35325   16998 25961   na na
  Mean $/month     1515 5183   1311 5652   1598 4975   na na
Other Relative 125,782     1,223     32,973     91,586    
  Mean Total $   12785 18178   20224 30634   14318 24154   12134 15140
  Mean $/month     1363 5308   1798 2748   1480 5709   1315 5182
Non-Relative 131,809     1,423     48,557     81,829    
  Mean Total $   13657 20134   18392 34044   15238 27665   12637 13258
  Mean $/month     1520 4490   1781 4823   1635 5357   1447 3877
New Recipients 51,394     1,473     20,205     29,716    
Grand Totalb   6456 17349   6839 21529   8503 24603   5045 9011
  Mean $/month     1243 4687   1071 3253   1684 6280   952 3231
Spouse 1,689     na     981     708    
  Mean Total $   5775 15149   na na   7174 17190   3835 11482
  Mean $/month     1134 3284   na na   1392 3757   777 2441
Parent 2,750     902     1,848     na    
  Mean Total $   8170 19877   5535 17660   9457 20757   na na
  Mean $/month     1288 3152   868 2785   1493 3298   na na
Other Relative 24,342     226     7,331     16,785    
  Mean Total $   6448 17669   11576 37456   8625 27985   5428 9407
  Mean $/month     1105 3230   1547 4968   1489 4664   932 2282
Non-Relative 22,613     345     10,045     12,223    
  Mean Total $   6307 16806   7147 15150   8368 23188   4590 8234
  Mean $/month     1395 6053   1292 2920   1890 7746   991 4228

SOURCE: California Department of Health Care Services, Medicaid claims, 2005

  1. Services included in the compilation of expenditures include personal assistance/home care, home health, inpatient hospital and nursing home care, physicians, clinics, outpatient departments, ancillary providers, physical/occupational/speech therapy, durable medical equipment, vision and hearing services, and mental health services. Excluded are payments for pharmacy products, and expenditure by Medicare, VA, out of pocket, or other payers.

TABLE 13: Adjusted Mean Monthly Medicaid Expenditures by IHSS Recipient Age, 2005a

Predictors Age 3-17g
n=11,002
Age 18-64
n=123,813
Age 65+
n=206,579
B   Pr >|t|   B   Pr >|t|   B   Pr >|t|  
  Intercept   -1.056   **   -1.219   ****   -0.346   ****
Recipient Characteristicsb
  Female Recipient 0.114   -0.325 **** -0.073 ***
  Hispanic -0.080   -0.022   -0.098 ****
  Blacka -0.015   0.094 * -0.046  
  Asian/Other -0.056   -0.058   -0.012  
  3+ Cognitive Limitationsc -0.617 **** -0.745 **** -0.155 *
  3+ ADL Limitationsd 0.023   0.243 **** 0.189 ****
  Breathing Limitationse 1.681 **** 0.840 **** 0.151 ***
  Household size (1-5+)f 0.087   0.095 *** 0.049 ****
  Number Health Conditionsg 0.360 **** 0.345 **** 0.171 ****
IHSS Providersh
  Spouse Provider na   -0.979 **** -0.773 ****
  Parent Provider -0.920 **** -0.012   na  
  Relative Provider -0.049   -0.172 **** -0.103 ****
  Total Authorized Hours 0.008 **** 0.011 **** 0.011 ****
County Characteristics
  Per Capita Income 0.018 ** 0.008 **** 0.007 ****
New IHSS Recipient -0.019   0.270 **** -0.152 ****
Model Goodness of Fit
  Adjusted R2 .087 **** .057 **** .0268 ****

* p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001

  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, home health, inpatient hospital and nursing home care, physicians, clinics, outpatient departments, ancillary providers, physical/occupational/speech therapy, durable medical equipment, vision and hearing services, and mental health services. Not included are pharmacy-related reimbursements, and expenditures by Medicare, the VA, out of pocket, or other payers.
  2. Reference is White. Race/ethnicity Asian/Other by descending number, Chinese, Filipino, Vietnamese, Korean, Laotian, Cambodian, Asian Indian, American Indian or Alaskan Native, Japanese, Samoan, and all others.
  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 an 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. Refers to HCC, summing the number of each of 23 subgroups of this classification schema.
  8. Reference is Non-Relative provider, “na” means the provider type was not included in the model.

TABLE 14: Mean Monthly Medicaid Inpatient Expenditures by IHSS Recipient Age and Provider Type, 2005

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  
All Recipients   87508         1439         28881         57188      
Grand Total   7,182 29717   22543 47847   12708 41465   4005 19850
  Mean $/months     1,101 7728   2466 7540   1928 9611   649 6536
Spouse 3403     na     1923     1480    
  Mean Total $   8065 28046   na na   10717 28631   4619 26889
  Mean $/month     1184 5008   na na   1618 5711   620 3842
Parent 3745     1118     2627     na    
  Mean Total $   16375 45401   22454 46229   13787 44803   na na
  Mean $/month     2049 10189   2408 7557   1896 11120   na na
Other Relative 38236     166     9468     28602    
  Mean Total $   6766 28507   20237 48727   12553 40746   4771 22517
  Mean $/month     1023 8588   2125 5783   1798 9812   761 8140
Non-Relative 42124     155     14863     27106    
  Mean Total $   6671 29021   25652 57590   12873 42685   3162 15985
  Mean $/month     1081 6766   3249 8946   2056 9594   533 4400
Continuing 77671     1314     24625     51732    
Total   6986 29267   22577 47924   12369 40732   4028 20232
  Mean $/months     991 7547   2368 7571   1681 9213   627 6576
Spouse 2908     na     1657     1251    
  Mean Total $   8102 29014   na na   10640 29334   4740 28247
  Mean $/month     1097 5037   na na   1480 5699   591 3941
Parent 3401     1034     2367     na    
  Mean Total $   16215 46229   22705 47164   13379 45535   na na
  Mean $/month     1959 10522   2361 7727   1784 11530   na na
Other Relative 33737     146     7945     25646    
  Mean Total $   6639 27429   18534 39280   12289 37449   4821 23077
  Mean $/month     970 8884   1833 3848   1653 10017   753 8512
Non-Relative 37625     134     12656     24835    
  Mean Total $   6377 28761   25989 60698   12456 42978   3174 16159
  Mean $/month     914 5895   3002 9237   1705 8548   499 3800
New in 2005 9837     125     4256     5456    
Total   8724 33015   22190 47229   14669 45427   3779 15776
  Mean $/months     1972 8985   3502 7149   3355 11545   859 6136
Spouse 495     na     266     229    
  Mean Total $   7848 21516   na na   11199 23824   3956 17748
  Mean $/month     1692 4809   na na   2477 5717   779 3251
Parent 344     84     260     na    
  Mean Total $   17957 36226   19367 32655   17501 37355   na na
  Mean $/month     2932 5908   2994 5010   2911 6179   na na
Other Relative 4499     20     1523     2956    
  Mean Total $   7713 35553   32665 93057   13929 54816   4341 16888
  Mean $/month     1425 5907   4255 13113   2550 8630   826 3546
Non-Relative 4499     21     2207     2271    
  Mean Total $   9127 30998   23507 32131   15264 40891   3030 13936
  Mean $/month     2477 11654   4819 6772   4068 14008   910 8547

SOURCE: Derived from California Department of Health Care Services, Medicaid claims with vendor codes of either 50 (county hospital -- acute inpatient) or 60 (community hospital -- acute inpatient) indicating hospital inpatient claims. Expenditures shown under count expenditures in the IHSS recipient population as the figures shown exclude persons in managed care for portions of 2005. “na” means that expenditures were not compiled for this provider type.


TABLE 15: Unadjusted Probability of Medicaid-Paid “Any Cause” Hospital Days, 2005

Provider Type Any Inpatient Days
No Yes Total % Yes
Recipients Age 3-17
  Parent 6,667 1,118 7,785 14.3%
  Other Relative 1,283 166 1,449 11.5%
  Non-Relative   1,613 155 1,768 8.8%
  Total 9,563 1,439 11,002 13.1%
Recipients Age 18-64
  Spouse 4,359 1,923 6,282 30.6%
  Parent 15,998 2,627 18,625 14.1%
  Other Relative 30,836 9,468 40,304 23.5%
  Non-Relative 43,739 14,863 58,602 25.4%
  Total 94,932 28,881 123,813 23.3%
Recipients Age 65+
  Spouse 2,676 1,480 4,156 35.6%
  Other Relative 79,769 28,602 108,371 26.4%
  Non-Relative 66,946 27,106 94,052 28.8%
  Total   149,391     57,188     206,579     27.7%  

SOURCE: Derived from California Department of Health Care Services, Medicaid claims with vendor codes of either 50 or 60 indicating hospital inpatient claims. Events shown under count actual use as they exclude persons in managed care for portions of the period, and stays paid fully by non-Medicaid sources.


TABLE 16: Adjusted “Any Cause” Hospital Use by IHSS Recipient Age & Provider Type, 2005a

Predictors Age 3-17
n=11,002
Age 18-64
n=123,813
Age 65 or More
n=206,579
  Odds Ratio   95% CI   Odds Ratio   95% CI   Odds Ratio   95% CI
Recipient Characteristics
  Female Recipient 0.92 0.80-1.05 0.79 0.77-0.82 0.84 0.82-0.86
  Hispanicb 0.83 0.70-0.98 1.29 1.24-1.34 1.22 1.19-1.26
  Blackb 1.32 1.07-1.64 1.37 1.32-1.42 1.32 1.27-1.37
  Asian/Otherb 0.89 0.67-1.16 0.76 0.72-0.81 1.16 1.25-1.20
  Household size (1-5+) 1.03 0.97-1.10 0.99 0.98-1.00 1.03 1.02-1.04
  3+ Cognitive Limitationsc   0.60 0.50-0.73 0.42 0.38-0.46 0.67 0.62-0.72
  3+ ADL Limitationsd 0.92 0.76-1.11 1.15 1.11-1.20 1.17 1.13-1.20
  Breathing Limitationse 1.43 1.22-1.68 1.78 1.69-1.88 1.82 1.74-1.91
  Number Health Conditionsf 1.62 1.58-1.66 1.40 1.40-1.41 1.69 1.68-1.70
IHSS Providersg
  Spouse na   1.15 1.08-1.23 1.01 0.93-1.09
  Parent 1.09 0.88-1.34 0.73 0.69-0.77 na  
  Other Relative 1.12 0.85-1.46 0.91 0.88-0.94 0.97 0.95-0.99
  Total Authorized Hours 1.00 1.00-1.00 1.00 1.00-1.00 1.01 1.00-1.01
County Characteristics
  Per Capita Income 1.00 0.99-1.01 1.00 1.00-1.01 0.99 0.99-0.99
New IHSS Recipient 0.56   0.44-0.70   0.67   0.64-0.70   0.43   0.42-0.45  
Model Goodness of Fit
  -2Log Likelihood 6132     108700       186851    
  Maximum Rescaled R2   0.364     0.284   0.348  

SOURCE: Derived from California Department of Health Care Services, Medicaid claims with vendor codes of either 50 or 60 indicating hospital inpatient claims. Events shown under count actual use as they exclude stays paid fully by 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 an 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. Unduplicated count of health conditions grouped into 23 subcategories using HCC.
  7. Reference is Non-Relative provider, “na” means the provider type was not included in the model.

TABLE 17: Unadjusted Probability of Medicaid-Paid Ambulatory Care Sensitive Condition-Related Hospital Days, 2005

Provider Type Any ACSC Inpatient Days
No Yes Total % Yes
Recipients Age 3-17
  Parent 7,657 128 7,785 1.6%
  Other Relative   1,430 19 1,449 1.3%
  Non-Relative 1,744 24 1,768 1.4%
  Total 10,831 171 11,002 1.6%
Recipients Age 18-64
  Spouse 5,752 530 6,282 8.4%
  Parent 18,016 609 18,625 3.3%
  Other Relative 37,500 2,804 40,304 7.0%
  Non-Relative 54,499 4,103 58,602 7.0%
  Total   115,767   8,046   123,813   6.5%
Recipients Age 65+
  Spouse 3,705 451 4,156   10.9%  
  Other Relative 99,487 8,884 108,371 8.2%
  Non-Relative 85,880 8,172 94,052 8.7%
  Total 189,072   17,507   206,579 8.5%

SOURCE: Derived from California Department of Health Care Services, Medicaid claims with vendor codes of either 50 or 60 indicating hospital inpatient claims. Events shown under count actual use as they exclude persons in managed care for portions of the period, and stays paid fully by non-Medicaid sources. ACSC refers to a set of conditions indicative of a potentially “avoidable” hospital stay. Separate standardized algorithms are used for children and adult age groups (AHRQ, 2007a, 2007b).


TABLE 18: Adjusted Ambulatory Care Sensitive Condition Hospital Use by IHSS Recipient Age and Provider Type, 2005a

Predictors Age 3-17
n=11,002
Age 18-64
n=123,813
Age 65 or More
n=206,579
OR 95% CI OR 95% CI OR 95% CI
Recipient Characteristics
  Female Recipient 1.10 0.80-1.51 0.79 0.75-0.83 0.86 0.83-0.90
  Hispanicb 0.98 0.65-1.47 1.35 1.27-1.44 1.31 1.26-1.37
  Blackb 1.56 0.94-2.56 1.68 1.59-1.78 1.38 1.30-1.45
  Asian/Otherb 1.43 0.75-2.72 0.92 0.83-1.02 1.23 1.17-1.29
  Household size (1-5+) 0.85 0.73-0.98 1.02 1.00-1.04 1.06 1.05-1.08
  3+ Cognitive Limitationsc   0.48 0.30-0.79 0.48 0.41-0.56 0.75 0.67-0.84
  3+ ADL Limitationsd 0.68 0.44-1.04 1.10 1.03-1.16 1.20 1.15-1.25
  Breathing Limitationse 1.31 0.92-1.88 2.62 2.44-2.80 2.60 2.48-2.74
  Number Health Conditionsf 1.48 1.41-1.55 1.32 1.31-1.33 1.36 1.36-1.37
IHSS Providersg
  Spouse na na 1.02 0.92 -1.14 0.86 0.78-0.97
  Parent 0.77 0.48-1.23 0.65 0.59-0.71 na na
  Other Relative 0.78 0.42-1.47 1.01 0.95-1.06 0.96 0.93-1.00
  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 0.99 0.96-1.02 1.00 0.99-1.00 0.99 0.99-0.99
New IHSS Recipient 0.61   0.34-1.08   0.62   0.58-0.66   0.47   0.44-0.50  
Model Goodness of Fit
  -2Log Likelihood 1413     50844       104751    
  Maximum Rescaled R2   0.212     0.178   0.161  

SOURCE: Derived from California Department of Health Care Services, Medicaid claims (vendor codes 50 or 60) indicating hospital inpatient claims. Events exclude stays paid fully by non-Medicaid sources. OR refers to odds ratio, CI refers to confidence interval.

  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 an 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. Unduplicated count of health conditions grouped into 23 subcategories using HCC.
  7. Reference is Non-Relative provider, “na” means the provider type was not included in the model.

TABLE 19: Unadjusted Probability of Medicaid-Paid Medical Care Use, 2005

Provider Type Any Use
No Yes Total % Yes
Recipients Age 3-17
  Parent 1,201 6,584 7,785 84.6
  Other Relative 434 1,015 1,449 70.0
  Non-Relative 597 1,171 1,768 66.2
  Total 2,232 8,770 11,002 79.7
Recipients Age 18-64
Spouse 351 5,931 6,282 94.4
  Parent 5,013 13,612 18,625 73.1
  Other Relative 4,549 35,755 40,304 88.7
  Non-Relative 7,579 51,023 58,602 87.1
  Total 17,492 106,321 123,813 85.9
Recipients Age 65+
Spouse 458 3,698 4,156 89.0
  Other Relative 20,755 87,616 108,371 80.8
  Non-Relative 16,919 77,133 94,052 82.0
  Total   38,132     168,447     206,579     81.5  

SOURCE: Derived from the California Department of Health Care Services, Medicaid claims. “Yes” means that a vendor group 5 (physicians, and physician groups, nurse practitioner, surgi-centers, rural health clinics) or a vendor group 6 (hospital outpatient departments, organized outpatient clinics) claim was present. Sample includes all eligible IHSS recipients, excluding those in managed care for one month or more in 2005.


TABLE 20: Unadjusted Probability of Medicaid-Paid Medical Care Use, Including Emergency Rooms, by IHSS Recipients, 2005

Provider Type Any Use
No Yes Total % Yes
Recipients Age 3-17
  Parent 1,045 6,740 7,785 86.6
  Other Relative 395 1,054 1,449 72.7
  Non-Relative 534 1,234 1,768 69.8
  Total 1,974 9,028 11,002 82.1
Recipients Age 18-64
  Spouse 294 5,988 6,282 95.3
  Parent 4,756 13,869 18,625 74.5
  Other Relative 4,328 35,976 40,304 89.3
  Non-Relative 7,081 51,521 58,602 87.9
  Total 16,459 107,354 123,813 86.7
Recipients Age 65+
  Spouse 364 3,792 4,156 91.2
  Other Relative 18,906 89,465 108,371 82.6
  Non-Relative 15,256 78,796 94,052 83.8
  Total 34,526 172,053 206,579 83.3

SOURCE: Derived from the California Department of Health Care Services, Medicaid claims. “Yes” means that a vendor group 5 (physicians, and physician groups, nurse practitioner, surgi-centers, rural health clinics) or a vendor group 6 (hospital outpatient departments, organized outpatient clinics) claim, or an ER claim was present. Sample includes all eligible IHSS recipients, excluding those in managed care for one month or more in 2005.


TABLE 21: Adjusted Medicaid-Paid Medical Care Use, Including Emergency Rooms, 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
  Odds Ratio   95% CI   Odds Ratio   95% CI   Odds Ratio   95% CI
Recipient Characteristics
  Female Recipient 0.98   0.82-1.18   0.93   0.88-0.98   0.94   0.90-0.97  
  Hispanicb 1.12 0.90-1.40 1.13 1.05-1.22 0.96 0.92-1.01
  Black 1.00 0.77-1.29 0.93 0.87-0.99 0.76 0.72-0.80
  Asian/Other 1.20 0.88-1.64 1.22 1.10-1.35 1.00 0.96-1.05
  Household size (1-5) 1.03 0.94-1.12 0.98 0.95-1.00 1.04 1.02-1.05
  3+ Cognitive Limitationsc 0.72 0.57-0.92 0.76 0.69-0.85 0.84 0.76-0.94
  3+ ADL Limitationsd 1.05 0.82-1.35 0.95 0.89-1.02 0.99 0.95-1.03
  Breathing Limitationse 0.95 0.72-1.26 1.03 0.92-1.16 0.99 0.92-1.07
  Number Health Conditionsf   19.9 17.0-23.4 10.6 10.2-11.0 7.44 7.27-7.61
IHSS Providersg
  Spouse na na 2.19 1.86-2.59 1.69 1.46-1.96
  Parent 1.54 1.23-1.92 0.83 0.78-0.90 na na
  Other Relative 0.94 072-1.26 1.05 0.98-1.12 1.03 1.00-1.07
  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 0.99 0.98-1.00 0.99 0.99-0.99 1.00 1.00-1.00
New IHSS Recipient 0.18 0.14-0.23 0.07 0.06-0.08 0.05 0.05-0.05
Model Goodness of Fit
  -2Log Likelihood 3302   35258   87211  
  Maximum Rescaled R2 0.776   0.723   0.642  

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. “na” not applicable

  1. 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+.
  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 an 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 5 or more.
  6. Unduplicated count of health conditions grouped into 23 subcategories using HCC.
  7. Reference is Non-Relative provider, “na” means the provider type was not included in the model.

TABLE 22: Unadjusted Probability of Medicaid-Paid Emergency Room Visits by IHSS Recipients, 2005

Provider Type Any ER Use
No Yes Total % Yes
Recipients Age 3-17
  Parent 3,073 4,712 7,785 60.5%
  Other Relative   737 712 1,449 49.1%
  Non-Relative 965 803 1,768 45.4%
  Total 4,775 6,227 11,002 56.6%
Recipients Age 18-64
  Spouse 1,968 4,314 6,282 68.7%
  Parent 10,308 8,317 18,625 44.7%
  Other Relative 16,762 23,542 40,304 58.4%
  Non-Relative 22,389 36,213 58,602 61.8%
  Total 51,427 72,386 123,813 58.5%
Recipients Age 65+
  Spouse 1,474 2,682 4,156 64.5%
  Other Relative 53,957 54,414 108,371 50.2%
  Non-Relative 43,282 50,770 94,052 54.0%
  Total   98,713     107,866     206,579     52.2%  

SOURCE: Derived from California Department of Health Care Services, Medicaid claims, 2005


TABLE 23: Adjusted Medicaid-Paid Emergency Room Visits 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
  Odds Ratio   95% CI   Odds Ratio   95% CI   Odds Ratio   95% CI
Recipient Characteristics
  Female Recipient 0.96   0.87-1.06   0.84   0.82-0.87   0.89   0.87-0.91  
  Hispanicb 0.98 0.87-1.11 1.22 1.17-1.26 1.16 1.13-1.20
  Black 1.26 1.08-1.47 1.41 1.36-1.46 1.20 1.16-1.25
  Asian/Other 0.87 0.72-1.05 0.72 0.69-0.76 0.96 0.93-0.98
  Household size (1-5) 0.98 0.94-1.03 0.99 0.98-1.00 1.04 1.03-1.05
  3+ Cognitive Limitationsc 0.74 0.64-0.86 0.56 0.52-0.60 0.66 0.62-0.72
  3+ ADL Limitationsd 1.07 0.93-1.22 1.10 1.06-1.14 1.11 1.08-1.14
  Breathing Limitationse 1.70 1.46-1.97 1.86 1.75-1.98 2.00 1.91-2.10
  Number Health Conditionsf   1.88 1.84-1.93 1.72 1.71-1.73 2.01 1.99-2.02
IHSS Providersg
  Spouse na na 1.20 1.12-1.29 1.27 1.17-1.38
  Parent 1.10 0.96-1.25 0.83 0.80-0.87 na na
  Other Relative 0.99 0.83-1.18 0.80 0.77-0.83 0.95 0.93-0.97
  Total Authorized Hours 1.00 1.00-1.00 1.00 1.00-1.00 1.01 1.01-1.01
County Characteristics
  Per Capita Income 0.99 0.99-1.00 0.99 0.99-1.00 0.99 0.99-1.00
New IHSS Recipient 0.45 0.38-0.52 0.45 0.43-0.46 0.35 0.34-0.36
Model Goodness of Fit
  -2Log Likelihood 10220   120103   205914  
  Maximum Rescaled R2 0.477   0.432   0.429  

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. “na” not applicable

  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 an 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. Unduplicated count of health conditions grouped into 23 subcategories using HCC.
  7. Reference is Non-Relative provider, “na” means the provider type was not included in the model.

TABLE 24: Mean Combined Medicaid-Paid Physician and Outpatient Department Expenditures by IHSS Recipients,a 2005

Variable 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  
All Recipients   8,770         106,321         168,447         8,770      
Grand Total     1741   8061     1483   3975     408   1519     1741   8061
  Mean $/months     177 780   178 573   45 203   177 780
Spouse na     5,931     3,698     na    
  Period Mean Total $   na na   1641 4095   540 1916   na na
  Mean $/month     na na   192 533   62 270   na na
Parent 6,584     13,612     na     6,584    
  Period Mean Total $   1860 9123   1089 5400   na na   1860 9123
  Mean $/month     184 864   117 550   na na   184 864
Other Relative 1,015     35,755     87,616     1,015    
  Period Mean Total $   1454 2978   1591 3898   398 1466   1454 2978
  Mean $/month     145 342   183 555   44 207   145 342
Non-Relative 1,171     51,023     77,133     1,171    
  Period Mean Total $   1316 3272   1493 3534   414 1555   1316 3272
  Mean $/month     166 503   189 594   46 195   166 503
Continuing Recipients 7,765     90,277     150,437     7,765    
Grand Total   1799 8480   1477 3963   409 1537   1799 8480
  Mean $/months     172 798   158 524   42 187   172 798
Spouse na     5,028     3,114     na    
  Period Mean Total $   na na   1581 3931   531 1962   na na
  Mean $/month     na na   166 483   52 183   na na
Parent 5,905     12,474     na     5,905    
  Period Mean Total $   1920 9569   1062 5521   na na   1920 9569
  Mean $/month     181 895   106 527   na na   181 895
Other Relative 885     29,769     77,540     885    
  Period Mean Total $   1459 2733   1589 3805   394 1459   1459 2733
  Mean $/month     138 273   165 513   40 183   138 273
Non-Relative 975     43,006     69,783     975    
  Period Mean Total $   1380 3326   1508 3500   420 1599   1380 3326
  Mean $/month     147 387   167 533   43 192   147 387
New Recipients 1,005     16,044     18,010     1,005    
Grand Total   1287 3334   1515 4037   405 1353   1287 3334
  Mean $/months     218 619   292 786   75 303   218 619
Spouse na     903     584     na    
  Period Mean Total $   na na   1976 4898   586 1649   na na
  Mean $/month     na na   342 735   116 530   na na
Parent 679     1,138     na     679    
  Period Mean Total $   1345 3220   1385 3812   na na   1345 3220
  Mean $/month     211 523   244 747   na na   211 523
Other Relative 130     5,986     10,076     130    
  Period Mean Total $   1422 4302   1602 4333   426 1524   1422 4302
  Mean $/month     196 636   276 722   75 335   196 636
Non-Relative 196     8,017     7,350     196    
  Period Mean Total $   998 2974   1416 3714   361 1042   998 2974
  Mean $/month     260 869   304 840   72 220   260 869

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), and 6 (hospital outpatient departments, organized outpatient clinics) are combined.

  1. 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 and 6 claims. “na” not applicable.

TABLE 25: Adjusted Mean Medicaid-Paid Medical Care Expenditures by IHSS Recipients, 2005a

Predictors Age 3-17g
n=8,770
Age 18-64
n=106,318
Age 65+
n=168,442
B   Pr >|t|   B   Pr >|t|   B   Pr >|t|  
  Intercept   -0.115   *   -0.193   ****   -0.026   ****
Recipient Characteristics
  Female Recipient -0.007   -0.027 **** -0.011 ****
  Hispanicb -0.039   0.006   -0.002  
  Blackb -0.009   0.020 **** 0.008 ****
  Asian/Otherb -0.028   0.004   -0.002  
  3+ Cognitive Limitationsc -0.022   -0.014   -0.000  
  3+ ADL Limitationsd -0.045 * 0.013 *** 0.004 **
  Breathing Limitationse 0.225   0.013 * -0.007 **
  Household size (1-5+)f 0.001   0.009 **** 0.002 ****
  Number Health Conditionsg   0.075 **** 0.062 **** 0.019 ****
IHSS Providersh
  Spouse Provider     -0.014   0.003  
  Parent Provider -0.015   0.002      
  Relative Provider -0.040   -0.014 *** 0.001  
  Total Authorized Hours 0.000   0.000   0.000  
County Characteristics
  Per Capita Income 0.001   0.001 **** 0.000 *
New IHSS Recipient 0.034   0.070 **** 0.017 ****
Model Goodness of Fit
  Adjusted R2 .067 **** .112 **** .048 ****

* p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001 
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), and 6 (hospital outpatient departments, organized outpatient clinics) are combined. Expenditures are divided by 1,000.

  1. Sample includes all eligible IHSS recipients, excluding those in managed care for one month or more in 2005. The number of care recipients may not equal the number of eligible recipients due to missing expenditure values or negative claims amounts.
  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 an 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. Refers to HCC, 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.

TABLE 26: Mean Monthly Medicaid-Paid Home and Community-Based Care Expenditures by IHSS Recipients, 2005a

Variable 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  
Community-Based Care
Grand Total 49   5786   8807 5192   12108   28274 34954   6605   5407 49   5786   8807
  Average $/month   556 900   1149 2677   620 565   556 900
Spouse                        
  Period Mean Total $   na na na 200 12065 22573 601 6766 11390 na na na
  Average $/month   na na   1133 2025   639 983   na na
Parent                        
  Period Mean Total $ 29 3940 4238 719 26201 43946 na na na 29 3940 4238
  Average $/month   373 408   2292 3710   na na   373 408
Other Relative                        
  Period Mean Total $ 10 9450 11803 1708 8366 17624 15899 6766 4607 10 9450 11803
  Average $/month   981 1486   793 1619   634 515   981 1486
Non-Relative                        
  Period Mean Total $ 10 7478 13761 2565 10653 27644 18454 6452 5730 10 7478 13761
  Average $/month   661 1130   1068 2851   608 586   661 1130
IHSS
Grand Total   3964   8509 7202   114743   8127 6774   198656   7639 5329   3964   8509 7202
  Average $/month   776 624   747 570   715 456   776 624
Spouse                        
  Period Mean Total $ na na na 1128 4410 5766 756 3734 4509 na na na
  Average $/month   na na   402 509   356 422   na na
Parent                        
  Period Mean Total $ 1109 5780 5500 18352 11132 8400 na na na 1109 5780 5500
  Average $/month   519 520   980 701   na na   519 520
Other Relative                        
  Period Mean Total $ 1415 9628 7428 39710 7105 5509 107004 7470 5087 1415 9628 7428
  Average $/month   869 621   663 462   702 436   869 621
Non-Relative                        
  Period Mean Total $ 1440 9510 7575 55553 7939 6713 90896 7871 5587 1440 9510 7575
  Average $/month   881 643   738 570   733 476   881 643
Any Unskilled Home Care
Grand Total 3983 8539 7327 115070 8650 9759 199622 8759 6580 3983 8539 7327
  Average $/month   779 639   797 865   820 575   779 639
Spouse                        
  Period Mean Total $ na na na 1279 5776 11452 1208 5703 9330 na na na
  Average $/month   na na   532 1024   541 818   na na
Parent                        
  Period Mean Total $ 1127 5789 5553 18381 12140 13726 na na na 1127 5789 5553
  Average $/month   521 522   1068 1157   na na   521 522
Other Relative                        
  Period Mean Total $ 1415 9695 7579 39731 7461 7056 107109 8468 6086 1415 9695 7579
  Average $/month   876 647   697 610   795 534   876 647
Non-Relative                        
  Period Mean Total $ 1441 9556 7742 55679 8412 9529 91305 9140 7050 1441 9556 7742
  Average $/month   885 656   786 885   852 614   885 656

SOURCE: Derived from California Department of Health Care Services, Medicaid claims, 2005, vendor codes 71 (HCBS), 73 (AIDS waiver), 81 (MSSP), and 89 (IHSS).

  1. Number of home care recipients does not equal the number of eligible recipients, as those in hospitals, nursing homes, or community facilities, or who may have no paid providers in a month do not receive IHSS payments.

TABLE 27: Adjusted Mean Monthly Medicaid-Paid Home and Community-Based Care Expenditures by IHSS Recipients, 2005a

Predictors Age 3-17g
n=3,983
Age 18-64
n=115,070
Age 65+
n=199,622
  B Pr >|t| B Pr >|t| B Pr >|t|
  Intercept -0.075   -0.246 **** -0.104 ****
Recipient Characteristicsb
  Female Recipient 0.019   -0.030 **** 0.001  
  Hispanic 0.021   -0.000   -0.087 ****
  Blacka 0.016   -0.009   -0.072 ****
  Asian/Other 0.032   0.003 ** -0.032 ****
  3+ Cognitive Limitationsc -0.209 **** -0.472 **** -0.288 ****
  3+ ADL Limitationsd 0.089 **** 0.058 **** 0.062 ****
  Breathing Limitationse 0.061 ** 0.272 **** -0.028 ****
  Household size (1-5+)f -0.012   0.003 * -0.007 ****
  Number Health Conditionsg 0.005 * -0.001 * 0.001 ***
IHSS Providersh
  Spouse Provider na   -0.430 **** -0.341 ****
  Parent Provider -0.520 **** -0.030 **** na  
  Relative Provider 0.027   0.003   -0.007 ****
  Total Authorized Hours 0.006 **** 0.009 **** 0.009 ****
County Characteristics
  Per Capita Income 0.009 **** 0.009 **** 0.009 ****
New IHSS Recipient -0.022   -0.022 **** 0.048 ****
Model Goodness of Fit
  Adjusted R2 .570 **** .412 **** .547 ****

* p<0.05, ** p<0.01, *** p<0.001, **** p<0.0001 
SOURCE: Medicaid claims-records maintained by the California Department of Health Care Services. Expenditures were compiled using vendor codes 71 (HCBS waiver), 73 (AIDS waiver services), 81 (MSSP waiver services), and 89 (IHSS). The number of home care recipients may not equal the number of eligible recipients, as those in hospitals, nursing homes, or community facilities do not receive IHSS payments.

  1. Sample includes all eligible IHSS recipients, excluding those in managed care for one month or more in 2005. Number of home care recipients does not equal the number of eligible recipients, as those in hospitals, nursing homes, or community facilities, or who may have no paid providers in a month do not receive IHSS payments.
  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 an 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. Refers to HCC, 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.

TABLE 28: Mean Monthly Medicaid-Paid Home Health Care Expenditures by IHSS Recipients, 2005a

  Age 3-17 Age 18-64 Age 65 or More
n Mean Std Dev n Mean Std Dev n Mean Std Dev
Home Health Care
Grand Total   882     52075     49281     4492     2613     11376     526     1200     3398  
  Average $/month   4970 6161   283 1017   151 387
Spouse na na na            
  Period Mean Total $   na na na 280 1244 1590 30 1222 1349
  Average $/month na na na   160 273   176 185
Parent             na na na
  Period Mean Total $ 642 52571 49723 552 9359 25834 na na na
  Average $/month   5069 6682   890 2275 na na na
Other Relative                  
  Period Mean Total $ 109 55393 49214 1392 1527 7112 302 1159 3661
  Average $/month   4925 4283   163 616   141 362
Non-Relative                  
  Period Mean Total $ 131 46887 47101 2268 1807 7081 194 1259 3199
  Average $/month   4523 4644   224 668   163 443

SOURCE: Unpublished tables derived from California Department of Health Care Services, Medicaid claims using vendor code 44 (home health agency), 2005. “na” not applicable.

  1. Number of home health care recipients may not equal the number of eligible recipients, as those in hospitals, nursing homes, or community facilities do not receive IHSS payments.

TABLE 29: Unadjusted Probability of Medicaid-Paid Nursing Home Stays by IHSS Recipients, 2005

Provider Type Any Nursing Home Stays
No Yes Total % Yes
Recipients Age 3-17
  Parent 10,458 31 10,489 0.30%
  Other Relative   2,077 3 2,080 0.14%
  Non-Relative 2,473 5 2,478 0.20%
  Total 15,008 39 15,047 0.26%
Recipients Age 18-64
  Spouse 7,097 179 7,276 2.46%
  Parent 23,043 271 23,314 1.16%
  Other Relative 48,041 991 49,032 2.02%
  Non-Relative 67,757 1,911 69,668 2.74%
  Total 145,938 3,352 149,290 2.25%
Recipients Age 65+
  Spouse 4,253 318 4,571 6.96%
  Other Relative 116,693 5,771 122,464 4.71%
  Non-Relative 95,745 7,375 103,120 7.15%
  Total   216,691     13,464     230,155     5.85%  

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 30: Adjusted Medicaid-Paid Nursing Home Use by Adult IHSS Recipients, 2005a

Predictors Age 18-64
n=149,290
Age 65 or More
n=230,155
  Odds Ratio   95% CI   Odds Ratio   95% CI
Recipient Characteristics
  Female Recipient 0.89   0.83-0.95   0.98   0.94-1.02  
  Hispanicb 0.95 0.86-1.04 0.96 0.92-1.01
  Blackb 0.94 0.86-1.02 1.17 1.11-1.23
  Asian/Otherb 0.78 0.67-0.89 0.80 0.76-0.84
  Householdsize (1-5) 0.96 0.93-0.98 0.95 0.93-0.96
  3+ Cognitive Limitationsc   0.34 0.28-0.42 0.95 0.86-1.05
  3+ ADL Limitationsd 1.52 1.40-1.66 1.35 1.29-1.41
  Breathing Limitationse 1.16 1.03-1.30 1.16 1.08-1.23
IHSS Providersf
  Spouse 0.82 0.70-0.97 0.98 0.86-1.10
  Parent 0.44 0.38-0.50 na  
  Other Relative 0.83 0.77-0.90 0.70 0.68-0.73
  Total Authorized Hours 1.00 1.00-1.00 1.00 1.00-1.00
County Characteristics
  Per Capita Income 1.02 1.01-1.02 1.00 1.00-1.00
New IHSS Recipients 1.09 0.99-1.20 0.87 0.82-0.92
Managed Care=yes 0.29 0.25-0.34 0.34 0.31-0.37
Model Goodness of Fit
  -2Log Likelihood 30885   98977  
  Maximum Rescaled R2 0.041   0.043  

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 (n=34) 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 an 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. Reference is Non-Relative provider, “na” means the provider type was not included in the model.

TABLE 31: Mean Monthly Medicaid-Paid Nursing Home Expenditures by IHSS Recipients, 2005

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  
All Recipients   16855         39         3352         13464      
Grand Total     12287   15963     46041   66074     12313   17314     12183   15124
  Mean $/months   3661 8777   19649 50432   3268 7496   3713 8631
Spouse 497     na     179     318    
  Period Mean Total $     10372 15958   na na   10877 16319   10088 15770
  Mean $/month   2924 7724   na na   3049 9282   2853 6705
Parent 302     31     271     na    
  Period Mean Total $   19504 33318   45108 69752   16575 24759   na na
  Mean $/month   5628 19777   20782 54946   3895 8438   na na
Other Relative 6765     3     991     5771    
  Period Mean Total $   11945 15184   26480 12769   11890 15827   11947 15070
  Mean $/month   3255 7870   4195 2505   2778 6151   3337 8129
Non-Relative 9291     5     1911     7375    
  Period Mean Total $   12405 15585   63558 65007   12063 16784   12458 15130
  Mean $/month   3932 8857   21897 36348   3453 7788   4044 9062
Continuing 14861     36     2811     12014    
Grand Total   12786 16438   49071 67906   12962 18068   12637 15507
  Mean $/months   3755 9005   21178 52250   3288 7694   3812 8805
Spouse 425     na     156     269    
  Period Mean Total $   10884 16790   na na   11239 17027   10679 16680
  Mean $/month   3057 8201   na na   3219 9888   2964 7059
Parent 267     29     238     na    
  Period Mean Total $   20865 34634   47927 71304   17568 25399   na na
  Mean $/month   5962 20889   22182 56597   3986 8671   na na
Other Relative 6004     3     837     5164    
  Period Mean Total $   12374 15538   26480 12769   12478 16365   12349 15400
  Mean $/month   3367 7995   4195 2505   2852 6345   3450 8231
Non-Relative 8165     4     1580     6581    
  Period Mean Total $   12924 16065   74305 69747   12695 17612   12942 15533
  Mean $/month   4005 9084   26636 40147   3421 7935   4131 9280
New in 2005 1994     3     541     1450    
Grand Total   8568 11163   9684 10268   8943 12166   8426 10771
  Mean $/months   2962 6807   1302 1484   3162 6374   2891 6968
Spouse 72     na     23     49    
  Period Mean Total $   7349 9203   na na   8420 10237   6846 8743
  Mean $/month   2133 3803   na na   1895 2593   2245 4274
Parent 35     2     33     na    
  Period Mean Total $   9117 17813   4240 5750   9412 18291   na na
  Mean $/month   3079 6429   483 622   3236 6592   na na
Other Relative 761     0     154     607    
  Period Mean Total $   8560 11491         8696 12052   8526 11354
  Mean $/month   2377 6745         2377 4964   2377 7130
Non-Relative 1126     1     331     794    
  Period Mean Total $   8635 10794   20572 --   9048 11634   8447 10425
  Mean $/month   3406 6979   2939 --   3607 7057   3323 6953

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.

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