Table 13B: Dually Eligible HCBS Participants

Assessing the Health and Welfare of the HCBS Population

Table 13: Outcome Indicators by Key Attributes of State Medicaid and Long-Term Care Environment, 2005a

Select for:

Outcome IndicatorNo Medically Needy ProgramMore Restrictive Eligibility CriteriaLess Restrictive Eligibility CriteriaNursing Home Level of Care Eligibility Criteria for HCBSPercentage of State LTC Funds Spent on HCBS
Short-Term Complications of Diabetes279265177407233158203272
Asthma or Chronic Obstructive Pulmonary Disease5,3344,3243,2614,5524,2593,1563,5744,841
Congestive Heart Failure6,7866,6104,8126,6486,3774,8215,1037,074
Composite: Potentially Preventable Infection11,10410,1437,16410,5149,9627,3578,05310,649
    Bacterial Pneumonia6,8776,0294,4676,0806,0194,6315,0256,331
    Urinary Tract Infection4,2274,1142,6974,4343,9422,7263,0284,318
Infection Due to Device or Implant873807600902785618661844
Composite: ACSC Chronic Conditions15,26914,04110,71514,67913,64410,26011,42115,100
Composite: ACSC Acute Conditions10,3649,2766,5599,3579,2846,6807,4319,753
Composite: ACSC Overall25,63023,31517,27324,03422,92616,93918,85124,850
Pressure Ulcer4,3064,2213,4134,5234,1553,0583,4544,564
Injurious Falls479395313320460331310477


ACSC = ambulatory care-sensitive condition; HCBS = home and community-based services; I/DD = intellectual and development disabilities; SMI = serious mental illness; LTC = long-term care.

a. All outcome indicators expressed as potentially avoidable hospital stays per 100,000 persons in the HCBS population. HCBS population for outcome indicators excludes: individuals under age 18; people with only institutional use in a given quarter; people on managed care plans; and persons in the States of Arizona, Maine, Washington, and Wisconsin.

Dually eligible = dually eligible for Medicaid and Medicare. Eligibility for Medicare defined as inclusion in Medicare denominator file.

Medicaid only = part of Medicaid HCBS population but not enrolled in Medicare.

HCBS subpopulations of I/DD, SMI, Under 65 Without I/DD or SMI, and 65+ are defined as in the Appendix.

Median is defined as the value at which half of States are below and half of States are above.

Source for Outcome Indicators: Agency for Healthcare Research and Quality (AHRQ), Medicaid Analytic eXtract (MAX) data, and Medicare Provider Analysis and Review (MedPAR) data.

Sources for column heading data are described in the Appendix.

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Page last reviewed December 2012
Internet Citation: Table 13B: Dually Eligible HCBS Participants: Assessing the Health and Welfare of the HCBS Population. December 2012. Agency for Healthcare Research and Quality, Rockville, MD.