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Basic report
Transition Rates from the Community to Nursing

Transition Rates from the Community to Nursing Home Care among Older Adult Medicaid Enrollees, 2006-2009

Rosemary Borck and Robert Schmitz Mathematica Policy Research Pamela Doty and John Drabek Office of the Assistant Secretary for Planning and Evaluation Printer Friendly Version in PDF Format (23 PDF pages)
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Transition Rates from the Community to Nursing

Transition Rates from the Community to Nursing Home Care among Older Adult Medicaid Enrollees, 2006-2009

This study is a follow-up to earlier research conducted with 2006 and 2009 Medicaid (MAX) data on interstate variations on the extent of the "re-balancing" of Medicaid long-term services and supports (LTSS) from nursing home care toward greater reliance on home and community-based services (HCBS). The present study reports interstate variations in
  • TranRateRB.pdf
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Guide to Assisted Living and State Policy

Guide to Assisted Living and State Policy

From: Guide to Assisted Living and State Policy
  • alspguide.pdf
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Appendixes (new)

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

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REFERENCES

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

Aday LA, R Anderson. (1974). A framework for the study of access to medical care.  Health Services Research,  9(3):208-220. Agency for Healthcare Research and Quality (AHRQ). (2007a).  Pediatric Quality Indicators, Revision 3.1 . Internet address: http://www.qualityindicators.ahrq.gov/software.htm .
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Implications for Medicaid and IHSS Expenditures

Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Implications for Medicaid and IHSS Expenditures

For all recipient age groups, IHSS expenditures, adjusting impairment severity and service needs, are expected to be lower relative to those with Non-Relative providers when Parents, Spouses, and Other Relatives living in the household are paid IHSS providers. This cost difference arises because an IHSS algorithm adjusts the authorized time for ho
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Recipients Age 65 or More

Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Recipients Age 65 or More

Spouses were present among about 25% of this age group of IHSS recipients, but except for those paid as Spouse providers, the number able/available reduced to about 3%. When a recipient’s provider was an Other Relative or a Non-Relative, almost half of the spouses present were also IHSS recipients. Recipients with IHSS-paid Spouse providers tend
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Recipients Age 18-64

Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Recipients Age 18-64

Spouse providers were rarely available as a choice to the non-aged adults participating in IHSS. Most IHSS recipients in this age group were either not married or their spouses were also IHSS recipients or otherwise not able physically/mentally to be paid caregivers. However, when spouses were available and able, the “preference” for them appe
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Recipients Age 3-17

Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Recipients Age 3-17

Minor children in IHSS generally have at least one parent in the home. Consequently, for most of these children, the choice of Parent/Non-Parent provider was possible and the choice made by families was for a Parent provider (70% overall and 80% when a parent was present in the home). Hispanics had the highest proportion selecting Parent providers
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Preferences in the Selection of Paid IHSS

Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Preferences in the Selection of Paid IHSS Providers and Outcomes

The selection of a parent or spouse as a paid provider, across all age groups, is partly a function of available family members, but differences in the proportion among race/ethnic groups “selecting” each of the various provider types suggests that cultural preferences may be an important selection factor. Wage and other possible influences on
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IHSS Plus vs. the Residual Program Participation

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

The number of recipients cared for by spouses and parents of minors paid as IHSS providers remained relatively constant between 2004 (under the IHSS Residual Program) and 2005 (under the IHSS Plus Waiver); as did the number of persons (about 1,600 recipients combined in 2005) participating in the Restaurant Meal voucher and Advance Pay waiver-elig
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CONCLUSIONS

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

California has paid legally responsible relatives as IHSS providers for years under a state and county financed component of IHSS known as the Residual Program. Many of the Residual Program elements were assumed into the IHSS Plus Waiver, implemented in 2005. This waiver allows Medicaid participation in jointly financing the PAS provided by parent
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Medicaid-Paid Nursing Home Use and Expenditures

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

The occurrence of nursing home use is derived from Medicaid-reimbursement claims. We have limited the use of claims to those occurring during or following the period in which the individual was a recipient in the IHSS program. Only nursing home stays occurring in 2005 are counted. 40  The claims (both payments and stays) available do not includ
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Home Health Care Expenditures

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

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
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Home and Community-Based Service Use and

Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Home and Community-Based Service Use and Expenditures

IHSS recipients may have access to Medicaid funded home care services in addition to IHSS. These can include several Medicaid HCBS waiver (e.g., AIDS waiver, Multi-Purpose Senior Services Program (MSSP), and developmental disabilities). 37  The first panel of Table 26, shows the use of these waiver services (i.e., excluding IHSS). It is propor
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Medical Care Expenditures

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

The final analysis of medical care use examines expenditures made for physician services, outpatient departments, and the aggregation of these services into combined medical care services. Unadjusted monthly Medical care service expenditures averaged over the recipients’ IHSS eligibility months in 2005 are shown in Table 24. This table has thre
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Emergency Room Use

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

The preceding results, show relatively comparable access to medical care across race/ethnic groups, and between recipients in the IHSS provider groups. However, claims data are not sufficient for determining the quality, timeliness, or appropriateness of this care. Here we separately examine the use of ERs. ERs can serve as alternatives for those
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Medicaid Physician and Outpatient Department Use

Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Medicaid Physician and Outpatient Department Use

Differences in hospital use described in the preceding section are more evident comparing White to non-White IHSS recipients than in comparisons among recipient-provider groups. In this section, we examine the use of physician and outpatient departments as a potential influence on hospital use. Access to medical care is necessary to assure appropr
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Medicaid Hospital Expenditures and Use

Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Medicaid Hospital Expenditures and Use

This section begins an examination of some of the component services that contribute to the total Medicaid expenditures. We begin with hospital use, often a contributor to high expenditures. Hospital use may also serve as an indicator for problems in medical care and quality of home care. Table 14 shows unadjusted mean expenditures for hospital
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Monthly Medicaid Expenditures

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

Across all age groups participating in IHSS, mean unadjusted Medicaid expenditures (excluding pharmacy payments) range from $1,400 to $1,700 per IHSS participation month. This is a cost inclusive of Medicaid-reimbursed personal assistance-related expenses, which averaged about $825 in 2005. The highest average total expenditures are among those ag

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