Home health and home care in Massachusetts after the Balanced Budget Act of 1997: implications of cost containment pressures for service authorizations.
This paper explores the response of the Massachusetts state-funded home care program for the elderly when its clients encountered barriers to the receipt of home health services because of HMO enrollment and the implementation of the Balanced Budget Act of 1997. Clients of three regional case management agencies serving the Massachusetts state home care program whose home care services were interrupted because of hospitalization between January 1 and April 30, 1999 and whose services were resumed after they returned home were studied. Detailed data are reported that show how the long-term personal assistance services provided through the state program were often complemented by temporary home health services after elders returned home. The multivariate analysis revealed that the authorization of state-funded personal care services was keyed to the status of home health aide services. After hospitalization, the presence of a home health aide reduced the likelihood of authorization of personal care. At final assessment, the situation was reversed, that is, the withdrawal of a home health aide increased the likelihood of authorization of personal care. The findings suggest that more restrictive Medicare reimbursement policies for home health services led to greater state expenditures for personal care services. In other words, less generous Medicare financing shifted a greater portion of the burden of financing home care to the state of Massachusetts. These findings raise important policy questions about the balance of responsibility between the federal government and states to provide financing of home care services for the elderly.
Caro
Francis G
FG
Gerontology Institute, University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125-3393, USA.
Porell
Frank W
FW
Sullivan
Donna M
DM
Safran-Norton
Clare E
CE
Miltiades
Helen
H
D000368:Aged; D002017:Budgets / Q000331:legislation & jurisprudence; D003363:Cost Control; D003482:Custodial Care / Q000191:economics* / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006279:Health Maintenance Organizations; D006699:Home Care Services / Q000191:economics* / Q000706:statistics & numerical data; D018576:Home Health Aides; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence*; D008297:Male; D008404:Massachusetts; D006278:Medicare / Q000331:legislation & jurisprudence*; D015999:Multivariate Analysis; D010548:Personal Health Services / Q000191:economics* / Q000706:statistics & numerical data; D012044:Regression Analysis; D013221:State Health Plans / Q000191:economics*; D014481:United States