The relative benefits and cost of medicaid home- and community-based services in Florida.
OBJECTIVE
We compared inpatient days, nursing home days, and total Medicaid claims for five Medicaid-funded home- and community-based services (HCBS) programs for in-home and assisted living services in Florida.


METHODS
We studied a single cohort of Medicaid enrollees in Florida aged 60 and older, who were enrolled for the first time in any of five Medicaid HCBS programs and who had at least one assessment (N=6,014). In this 3-year longitudinal study, we used a two-stage probit regression and ordinary least squares regression in order to test the independent effects of explanatory variables on outcomes and cost.


RESULTS
After controlling for differences in frailty, chronic health conditions, presence of dementia, and available caregiver, we found that Medicaid HCBS programs had a differential effect on hospital and nursing home utilization and cost.


CONCLUSIONS
Medicaid HCBS programs serve very impaired populations at a wide range of costs to Medicaid. The rates for Medicaid HCBS programs could be adjusted upward or downward in order to better reflect the level of need in each program. At the same time, providers could use titration techniques based on the relative costs of these needs in order to budget for the costs of meeting the needs of particular elders.
Mitchell
Glenn
G
State Data Center on Aging, School of Aging Studies, Florida Policy Exchange Center on Aging, University of South Florida, USF#30437, Tampa, FL 33620, USA. gmitchel@cas.usf.edu
Salmon
Jennifer R
JR
Polivka
Larry
L
Soberon-Ferrer
Horacio
H
D000368:Aged; D000369:Aged, 80 and over; D040561:Assisted Living Facilities / Q000191:economics; D003153:Community Health Services / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000191:economics*; D005260:Female; D005431:Florida; D016330:Frail Elderly; D006699:Home Care Services / Q000191:economics; D006707:Homes for the Aged / Q000191:economics*; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid / Q000191:economics*; D008875:Middle Aged; D009735:Nursing Homes / Q000191:economics*; D010343:Patient Admission / Q000191:economics; D013221:State Health Plans / Q000191:economics*; D014481:United States