Allowing spouses to be paid personal care providers: spouse availability and effects on Medicaid-funded service use and expenditures.
OBJECTIVE
Medicaid service use and expenditure and quality of care outcomes in California's personal care program known as In-Home Supportive Service (IHSS) are described. Analyses investigated Medicaid expenditures, hospital use, and nursing home stays, comparing recipients who have paid spouse caregivers with those having other relatives or unrelated individuals as their caregivers.


METHODS
Medicaid claims and IHSS assessment data for calendar year 2005 were linked for IHSS recipients aged 18 years or older (n = 386,447)


RESULTS
The rates of ambulatory care-sensitive hospital admissions and Medicaid-covered nursing home placements were at least comparable among IHSS recipients' with spouse, parent, other relative, or nonrelative caregivers. Statistically significant differences reflected more desirable outcomes for those with relatives as paid caregivers. In no comparisons did those with spouse providers have worse outcomes than those with nonrelative providers. Average monthly Medicaid expenditures for all services were also lower for IHSS recipients with family provider.


CONCLUSIONS
There were no financial disadvantages and some advantages to Medicaid in terms of lower average Medicaid expenditures and fewer nursing home admissions when using spouses, parents, and other relatives as paid IHSS providers. This argues in favor of honoring the recipient's and family's preference for such providers.
University of California-San Francisco, 3333 California Street, San Francisco, CA 94118, USA. robert.newcomer@ucsf.edu
Robert J
RJ
Newcomer
Taewoon
T
Kang
Pamela
P
Doty
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D017028:Caregivers / Q000191:economics*; D005190:Family; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008134:Long-Term Care / Q000191:economics*; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data*; D008875:Middle Aged; D009735:Nursing Homes / Q000191:economics* / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012648:Self Care; D018454:Spouses; D014481:United States; D000078329:Workforce; D055815:Young Adult