Table 13E: SMI Subpopulation

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 Diabetes621615359916463430443605
Asthma or Chronic Obstructive Pulmonary Disease5,9945,2854,2594,7244,8974,9754,5305,703
Congestive Heart Failure4,3593,5312,8293,3463,3993,7252,9484,100
Composite: Potentially Preventable Infection8,9878,4705,5518,5567,7807,0446,3728,804
    Bacterial Pneumonia5,6985,2633,7595,0754,9794,5974,2355,439
    Urinary Tract Infection3,2893,2081,7923,4812,8012,4472,1373,364
Infection Due to Device or Implant966853540836842780610947
Composite: ACSC Chronic Conditions14,03412,14410,12511,95011,30311,96410,49113,486
Composite: ACSC Acute Conditions8,6248,0185,3637,8917,5406,7976,1368,352
Composite: ACSC Overall22,65820,16115,48719,83618,84418,76216,62621,838
Pressure Ulcer3,4902,8922,1263,3142,6232,6792,2983,287
Injurious Falls340266175175314210190322


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 13E: SMI Subpopulation: Assessing the Health and Welfare of the HCBS Population. December 2012. Agency for Healthcare Research and Quality, Rockville, MD.