Table 13C: Medicaid-Only 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 Diabetes697487337934388364385567
Asthma or Chronic Obstructive Pulmonary Disease4,0203,1432,9713,0703,0032,8482,9223,696
Congestive Heart Failure3,1032,9602,7593,1422,8282,8492,4783,563
Composite: Potentially Preventable Infection5,9705,3224,1995,8815,0554,4854,3035,905
    Bacterial Pneumonia3,7053,2282,8053,4493,0893,0052,8823,494
    Urinary Tract Infection2,2652,0941,3942,4321,9671,4801,4202,411
Infection Due to Device or Implant1,0989885781,0198977426501,088
Composite: ACSC Chronic Conditions10,7709,1968,11710,3858,4658,0647,90210,707
Composite: ACSC Acute Conditions5,4224,5813,7205,0214,4274,0253,8265,144
Composite: ACSC Overall16,19013,77711,83715,40612,89012,08911,72815,849
Pressure Ulcer3,0313,0011,4163,0732,9141,2111,5913,369
Injurious Falls12277359089255582


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 13C: Medicaid-Only HCBS Participants: Assessing the Health and Welfare of the HCBS Population. December 2012. Agency for Healthcare Research and Quality, Rockville, MD.