title: Medicare and Medicaid home health and Medicaid waiver services for dually eligible older adults: risk factors for use and correlates of expenditures.
abstract: OBJECTIVE
  The purpose of this work was to, among frail dually eligible older adults, determine risk factors for the likelihood of using Medicare home health and Medicaid home health services and to, among service users, determine correlates of Medicare home health, Medicaid home health, and Medicaid waiver service expenditures.
  
  
  METHODS
  Dually eligible individuals enrolled in Connecticut's Medicaid home- and community-based services (HCBS) waiver program for the aged (N = 5,232) were identified from a statewide database containing person-level linked data from Medicare claims, Medicaid claims, and uniform clinical assessment forms. Expenditures, based on claims data, were observed from the month following clinical assessment over the period August 1995 to December 1997.
  
  
  RESULTS
  In multivariate models controlling for medical conditions and sociodemographic variables, similar functional disability measures were strongly associated with the probability of the use of, and expenditures for, Medicare home health and Medicaid home health services; severe cognitive impairment was strongly associated with greater Medicaid waiver service expenditures.
  
  
  CONCLUSIONS
  Given the similarity of factors associated with Medicare and Medicaid home health service use and expenditures, greater integration of Medicare and Medicaid financing, reimbursement, and delivery strategies for home health services may be feasible and warranted for dually eligible older adults enrolled in state Medicaid HCBS waiver programs.
authors.affiliation: Center on Aging, University of Connecticut Health Center, 263 Farmington Ave., Farmington, CT 06030-5215, USA. fortinsky@nso1.uchc.edu
authors.forename: Richard H
authors.initials: RH
authors.lastname: Fortinsky
authors.forename: Juliane R
authors.initials: JR
authors.lastname: Fenster
authors.forename: James O
authors.initials: JO
authors.lastname: Judge
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000191:economics; D003237:Connecticut; D006233:Persons with Disabilities; D004608:Eligibility Determination; D005260:Female; D016330:Frail Elderly; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D012307:Risk Factors; D014481:United States