Home and Community Based Waivers for Disabled Adults 成年残疾人家庭和社区为基础的豁免.pptVIP

Home and Community Based Waivers for Disabled Adults: Program versus Selection Effects Courtney Harold Van Houtven Durham Veteran’s Administration Duke University Marisa Elena Domino University of North Carolina Background Purpose of Waiver programs is to provide coverage for extra services to keep people in community In-home aide services Respite care Adult day health care Others Waivers for disabled adults operate in 47 of the 50 states Background Incentives exist for careful selection of enrollees by states States must select persons “At-risk” of institutionalization Care for the person must be cost-neutral. $2,553 to $3,360 per month for home care in NC Hence, states have incentives to select persons partially based on expected spending levels Objective To examine the impacts on costs of a Medicaid Home and Community-based Waiver program and whether differences are due to selection effects or true program effects, controlling for endogenous selection of persons into the program. Expands on Anderson Mitchell (1997, 2000) study of an AIDS Waiver program Continuous measure of waiver participation Multi-faceted severity measure Study Design Study Design We use severity to differentiate institutional risk and expected expenditures. Multi-faceted risk adjustment scale (CDPS) specially designed for disabled adults (Kronick, Gilmer et al., 2000). Predictive of future health care needs and differentiates severity based on expected expenditures. Data Sources North Carolina Medicaid claims and enrollment data from Fiscal Years 1999-2000 Area Resource File for North Carolina for county-level information State licensure information on home health agencies Sample All Medicaid adults with disabled or blind status who were continuously enrolled in Medicaid for the 2 year study period and had at least $10,000 in expenditures in FY 1999 N=27,056. Waiver participants=1,752 Methods Two-part expenditure models of Total Medicaid expenditures Nursing