State practices in providing health and long-term care to dually eligible persons (original) (raw)
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Health Economics, 2009
Individuals with dual enrollment in Medicare and Medicaid have become the focus of heightened US federal and state policy interest in recent years. These beneficiaries are among the most vulnerable and costly persons served by either program. This analysis uses a reduced-form econometric model and a unique survey of community-resident dual enrollees to take a critical step toward understanding the relationships and combinations of state long-term care (LTC) policies and their relative effectiveness in achieving their intended effects: increasing access to care, improving activities of daily living/instrumental activities of daily living (ADL/IADL) assistance, and reducing unmet needs. We then simulate the effects of alternative policies to determine the most effective combination.
Ohio's long-term care system : trends and issues
In both Ohio and the nation, long-term care has become a major component of the budget. In order to increase long-term care choices and slow the growth of expenditures, a number of changes to the long-term care system were implemented in 1993. These changes included a nursing home moratorium, pre-admission review for long-term care consumers, and an expansion of the PASSPORT program. Based on data gathered from nursing homes, the Ohio Department of Health, and the Ohio Department of Aging, this study examines changes in utilization of communitybased and institutional long-term care since 1993.
Providing Long-Term Services and Supports to an Aging Ohio : Progress and Challenges
2009
We wish to thank many people whose assistance made this study possible. At the Ohio Department of Aging we relied on Judy Walens to extract and send us data from the PASSPORT Information Management System (she does this for us annually); and Roland Hornbostel who provided ongoing feedback on project design and this final report; at the Ohio Department of Job and Family Services we received the help and guidance of Brooke Trisel and Matt Hobbs in obtaining Medicaid utilization data from the current and historical Medicaid Decision Support System; and at the Ohio Department of Health, Keith Weaver provided us with MDS data. We are grateful to them for their time and their patience in assisting us in understanding the data. We are equally grateful to the nursing home and residential care professional associations who supported our data collection efforts and to the 1450 facilities who responded to the surveys. We are also very appreciative of the efforts of the staff at the two PACE sites who copied and mailed us the PACE participants' assessments. At Scripps, we are thankful to Karl Chow for his great work on preparing the online survey of facilities, Hallie Baker for cleaning and analyzing residential care facility survey results, and Jerrolyn Butterfield for data entry and Tony Bardo for data entry and analyzing the past and current assessment records of the PACE program participants. We also benefitted from the editorial assistance of Michael Payne, and editorial and graphics support from Valerie Wellin, and outstanding report preparation work by Lisa Grant. We hope that this report will assist Ohio in its attempt to develop an efficient, effective, and compassionate system of longterm care for people of all ages. Medicaid long-term care expenditures, our projections indicate that unless the system is altered, the Medicaid program could consume half of the state budget by the year 2020. Because such expenditure increases are not politically or economically feasible, it is critical for Ohio to continue its work on system reform. We hope the findings and recommendations from this report can contribute to Ohio's efforts to create an efficient and effective system of long-term services and supports.
Health Services Research, 2014
Objective. To compare the probability of experiencing a potentially preventable hospitalization (PPH) between older dual eligible Medicaid home and community-based service (HCBS) users and nursing home residents. Data Sources. Three years of Medicaid and Medicare claims data (2003-2005) from seven states, linked to area characteristics from the Area Resource File. Study Design. A primary diagnosis of an ambulatory care sensitive condition on the inpatient hospital claim was used to identify PPHs. We used inverse probability of treatment weighting to mitigate the potential selection of HCBS versus nursing home use. Principal Findings. The most frequent conditions accounting for PPHs were the same among the HCBS users and nursing home residents and included congestive heart failure, pneumonia, chronic obstructive pulmonary disease, urinary tract infection, and dehydration. Compared to nursing home residents, elderly HCBS users had an increased probability of experiencing both a PPH and a non-PPH. Conclusions. HCBS users' increased probability for potentially and non-PPHs suggests a need for more proactive integration of medical and long-term care.
Medicare & Medicaid Research Review, 2013
Background: Dual eligible Medicare and Medicaid beneficiaries consume disproportionate shares of both programs. Objectives: To compare Medicare and Medicaid expenditures of elderly dual eligible beneficiaries with non-dual eligible beneficiaries based on their long-term care (LTC) use. Research Design: Secondary analysis of linked MAX and Medicare data in seven states. Subjects: Dual eligible adults (65+) receiving LTC in institutions, in the community, or not at all; and Medicare non-dual eligibles. Measures: Medicaid acute medical and LTC expenditures per beneficiary year, Medicare expenditures. Results: Among dual eligibles and non-dual eligibles, the average number of diseases and case mix scores are higher for LTC users. Adjusting for case mix virtually eliminates the difference for medical costs, but not for LTC expenditures. Adjusting for LTC status reduces the difference in LTC costs, but increases the difference in medical costs. Conclusions: Efforts to control costs for dual eligibles should target those in LTC while better coordinating medical and LTC expenditures.
Functional Disability and Health Care Expenditures for Older Persons
Archives of internal medicine, 2001
Background: The rapidly expanding proportion of the US population 65 years and older is anticipated to have a profoundeffectonhealthcareexpenditures.Whetherthechanging health status of older Americans will modulate this effect is not well understood. This study sought to determine the relationship between functional status and governmentreimbursed health care services in older persons. Methods: Longitudinal cohort study of a representative sample of community-dwelling persons 72 years or older. Clinical data were linked with data on 2-year expenditures for Medicare-reimbursed hospital, outpatient, and home care services and Medicare-and Medicaidreimbursed nursing home services. Per capita expenditures associated with different functional status transitions were calculated, as were excess expenditures associated with functional disability adjusted for demographic, health, and psychosocial variables. Results: The 19.6% of older persons who had stable functional dependence or who declined to dependence accounted for almost half (46.3%) of total expenditures. Persons in these groups had an excess of approximately $10000 in expenditures in 2 years compared with those who remained independent. The 9.6% of patients who were dependent at baseline accounted for more than 40.0% of home health and nursing home expenditures; the 10.0% who declined accounted for more than 20.0% of hospital, outpatient, and nursing home expenditures. Conclusions: Functional dependence places a large burden on government-funded health care services. Whereas functional decline places this burden on shortand long-term care services, stable functional dependence places the burden predominantly on long-term care services. Declining rates of functional disability and interventions to prevent disability hold promise for ameliorating this burden.