title: Payment rates for personal care assistants and the use of long-term services and supports among those dually eligible for Medicare and Medicaid.
abstract: OBJECTIVE
  To examine the association between payment rates for personal care assistants and use of long-term services and supports (LTSS) following hospital discharge among dual eligible Medicare and Medicaid beneficiaries.
  
  
  METHODS
  State hospital discharge, Medicaid and Medicare claims, and assessment data on California Medicaid LTSS users from 2006 to 2008.
  
  
  METHODS
  Cross-sectional study. We used multinomial logistic regression to analyze county personal care assistant payment rates and postdischarge LTSS use, and estimate marginal probabilities of each outcome across the range of rates paid in California.
  
  
  METHODS
  We identified dual eligible Medicare and Medicaid adult beneficiaries discharged from an acute care hospital with no hospitalizations or LTSS use in the preceding 12 months.
  
  
  RESULTS
  Personal care assistant payment rates were modestly associated with home and community-based services (HCBS) use versus nursing facility entry following hospital discharge (RRR 1.2, 95 percent CI: 1.0-1.4). For a rate of $6.75 per hour, the probability of HCBS use was 5.6 percent (95 percent CI: 4.2-7.1); at $11.75 per hour, 18.0 percent (95 percent CI: 12.5-23.4). Payment rate was not associated with the probability of nursing facility entry.
  
  
  CONCLUSIONS
  Higher payment rates for personal care assistants may increase utilization of HCBS, but with limited substitution for nursing facility care.
authors.affiliation: Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ko
authors.forename: Robert
authors.initials: R
authors.lastname: Newcomer
authors.forename: Taewoon
authors.initials: T
authors.lastname: Kang
authors.forename: Denis
authors.initials: D
authors.lastname: Hulett
authors.forename: Philip
authors.initials: P
authors.lastname: Chu
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Bindman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D003430:Cross-Sectional Studies; D063026:Dual Medicare Medicaid Eligibility; D005260:Female; D005102:Health Expenditures; D006801:Humans; D008134:Long-Term Care / Q000191:economics* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010548:Personal Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Long-term care; Medicaid; Medicare; home care/nursing homes; state health policies