title: Medicaid Personal Care Services and caregivers' reports of children's health: the dynamics of a relationship.
abstract: OBJECTIVE
  To investigate the relationship between Medicaid Personal Care Services (PCS) and caregivers' reports of activity (activities of daily living [ADL]) limitations for children with chronic health problems.
  
  
  METHODS
  Primary data collected in 2008 and 2009. A state Medicaid program was the setting. The focus was children receiving Medicaid PCS.
  
  
  METHODS
  Medicaid case managers assessed children to determine their need for PCS, using information provided by the child or informal caregivers. Two thousand seven hundred assessments were provided to researchers directly from case managers.
  
  
  RESULTS
  Medical conditions and impairments explained 58 percent of the variance in the child's activity limitations. Activity limitations and problem behaviors explained 28 percent of the variance in PCS hours authorized. Which case manager completed the assessment also played a substantial role in determining hours of care.
  
  
  CONCLUSIONS
  Caregivers' reports of the severity of a child's activity limitations effectively summarize the effects of conditions and impairments on the child's ADL performance and have a significant impact on the level of services provided. Assessors often respond differently to children's characteristics and circumstances as they move from assessment to decisions concerning care provision. Our results imply that the provision of appropriate services may be enhanced when both case managers and caregivers play an active role in decisions concerning care provision.
authors.affiliation: Texas A&M University, 4225 TAMU, College Station, TX 77843, USA. telliott@tamu.edu
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Elliott
authors.forename: Charles D
authors.initials: CD
authors.lastname: Phillips
authors.forename: Ashweeta
authors.initials: A
authors.lastname: Patnaik
authors.forename: Emily
authors.initials: E
authors.lastname: Naiser
authors.forename: Eric A
authors.initials: EA
authors.lastname: Booth
authors.forename: Constance J
authors.initials: CJ
authors.lastname: Fournier
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Miller
authors.forename: Darcy M
authors.initials: DM
authors.lastname: Moudouni
authors.forename: Catherine
authors.initials: C
authors.lastname: Hawes
authors.forename: James A
authors.initials: JA
authors.lastname: Dyer
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000458:organization & administration* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005260:Female; D006699:Home Care Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008607:Intellectual Disability; D008297:Male; D008484:Medicaid / Q000458:organization & administration* / Q000706:statistics & numerical data; D015588:Observer Variation; D010548:Personal Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012737:Sex Factors; D014481:United States