title: The relationship between formal and informal care among adult Medicaid Personal Care Services recipients.
abstract: OBJECTIVE
  To test hypotheses concerning the relationship between formal and informal care and to estimate the impact of hours of formal care authorized for Medicaid Personal Care Services (PCS) on the utilization of informal care.
  
  
  METHODS
  Data included home care use and adult Medicaid beneficiary characteristics from assessments of PCS need in four Medicaid administrative areas in Texas.
  
  
  METHODS
  Cross-sectional design using ordinary least-squares (OLS) and instrumental variable (IV) methods.
  
  
  METHODS
  The study database consisted of assessment data on 471 adults receiving Medicaid PCS from 2004 to 2006.
  
  
  RESULTS
  Both OLS and IV estimates of the impact of formal care on informal care indicated no statistically significant relationship. The impact of formal care authorized on informal care utilization was less important than the influence of beneficiary need and caregiver availability. Living with a potential informal caregiver dramatically increased the hours of informal care utilized by Medicaid PCS beneficiaries.
  
  
  CONCLUSIONS
  More formal home care hours were not associated with fewer informal home care hours. These results imply that policies that decrease the availability of formal home care for Medicaid PCS beneficiaries will not be offset by an increase in the provision of informal care and may result in unmet care needs.
authors.affiliation: Program on Aging, Long Term Care and Disability, Department of Health Policy and Management, School of Rural Public Health, Texas A&M Health Science Center (TAMU 1266), College Station, TX 77843, USA. dkmoudouni@srph.tamhsc.edu
authors.forename: Darcy K
authors.initials: DK
authors.lastname: McMaughan Moudouni
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ohsfeldt
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Miller
authors.forename: Charles D
authors.initials: CD
authors.lastname: Phillips
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D008484:Medicaid / Q000191:economics*; D008875:Middle Aged; D010548:Personal Health Services / Q000191:economics / Q000592:standards*; D014481:United States