Assessing the Health and Welfare of the HCBS Population

Findings Report

Under Section 6086(b) of the Deficit Reduction Act, the Agency for Healthcare Research and Quality (AHRQ) was assigned to develop outcome indicators to assess the "health and welfare" of recipients of Medicaid home- and community-based services (HCBS). AHRQ also was required to use the outcome indicators to describe the health and welfare of this population. The outcome indicators are presented by individual attributes and area characteristics. Because a primary area of HCBS policy interest is the relationship between HCBS outcomes and the HCBS environment in each State, the health of the HCBS population is also described within the context of State policies and service availability.

Prepared by:
R. Tamara Konetzka, PhD, Department of Health Studies, University of Chicago, Illinois
D.E.B. Potter, MS, Agency for Healthcare Research and Quality
Sarita L. Karon, PhD, Center for Health Systems Research and Analysis, University of Wisconsin–Madison

Contract No. 290-04-0020 and 290-2009-00010C (partial funding)

Contents

Introduction
HCBS Population
Availability and Use of State Medicaid HCBS
Outcome Indicators for the HCBS Population
Outcomes by HCBS Participant Characteristics
Conclusion
References
Technical Appendix

List of Tables
Table A: Indicator Rates for the HCBS and Full Medicaid Populations (Rates of Admission per 100,000 Persons)
Table 1: Availability of Medicaid State Plan Home and Community-Based Services, by State, 2005
Table 2: Availability of Selected Medicaid 1915(c) Waiver Home and Community-Based Services, by State, 2005
Table 3A: National Medicaid Home and Community-Based Services Population by Selected Characteristics, 2005
Table 3B: National Medicaid Home and Community-Based Services Population by Selected Characteristics, 2005 (by State)
Table 4: Home and Community-Based Services Population by 1915(c) Waiver Target Enrollment Group, 2005
Table 5: Number of Home and Community-Based Services Users by State With Use of Selected Medicaid Mandatory and Optional HCBS State Plan Services, 2005
Table 6: Number of Home and Community-Based Services Users by State With Use of 1915(c) Waiver Services, 2005
Table 7: Health and Welfare of the Home and Community-Based Services Population as Measured by 13 Outcome Indicators, 2005
Table 8: Outcome Indicators for the Home and Community-Based Services Population by Participant Attributes, 2005
   Table 8A: National HCBS Population
   Table 8B: Dually Eligible HCBS Participants
   Table 8C: Medicaid-Only HCBS Participants
   Table 8D: I/DD Subpopulation
   Table 8E: SMI Subpopulation
   Table 8F: HCBS Population Ages 18-64 Without I/DD or SMI
   Table 8G: HCBS Population Age 65+
Table 9: Outcome Indicators by Selected Home and Community-Based Services Medicaid State Plan Services Offered, 2005
Table 10: Outcome Indicators by Selected Home and Community-Based Services 1915(c) Waiver Services Offered, 2005
Table 11: Outcome Indicators by Use of Selected Home and Community-Based Services Medicaid State Plan Services, 2005
Table 12: Outcome Indicators by Use of Selected Home and Community-Based Services 1915(c) Waiver Services, 2005
Table 13: Outcome Indicators by Key Attributes of State Medicaid and Long-Term Care Environment, 2005
   Table 13A: National Home and Community-Based Services Population
   Table 13B: Dually Eligible HCBS Participants
   Table 13C: Medicaid-Only HCBS Participants
   Table 13D: I/DD Subpopulation
   Table 13E: SMI Subpopulation
   Table 13F: HCBS Population Ages 18-64 Without I/DD or SMI
   Table 13G: HCBS Population Age 65+
Table 14: Outcome Indicators by County and State Supply of Health Care Providers, 2005
   Table 14A: Outcome Indicators by County Supply of Health Care Providers
   Table 14B: Outcome Indicators by State Supply of Health Care Providers
Table 15: Outcome Indicators by County and State Demographics, 2005
   Table 15A: Outcome Indicators by County Demographics
   Table 15B: Outcome Indicators by State Demographics
Table 16: Outcome Indicators by County and State Socioeconomic Status, 2005
   Table 16A: Outcome Indicators by County Socioeconomic Status
   Table 16B: Outcome Indicators by State Socioeconomic Status
Table 17: Outcome Indicators by State Prevalence of Chronic Conditions, 2005
   Table 17A: National HCBS Population
   Table 17B: Dually Eligible HCBS Participants
   Table 17C: Medicaid-Only HCBS Participants
   Table 17D: I/DD Subpopulation
   Table 17E: SMI Subpopulation
   Table 17F: HCBS Population Ages 18-64 Without I/DD or SMI
   Table 17G: HCBS Population Age 65+
Table 18: Outcome Indicators by State Prevalence of Any Disability, 2005
   Table 18A: National HCBS Population
   Table 18B: Dually Eligible HCBS Participants
   Table 18C: Medicaid-Only HCBS Participants
   Table 18D: I/DD Subpopulation
   Table 18E: SMI Subpopulation
   Table 18F: HCBS Population Ages 18-64 Without I/DD or SMI
   Table 18G: HCBS Population Age 65+
Table 19: Outcome Indicators by State Prevalence of Specific Disabilities, Age 65+, 2005
   Table 19A: National HCBS Population
   Table 19B: Dually Eligible HCBS Participants
   Table 19C: Medicaid-Only HCBS Participants
   Table 19D: I/DD Subpopulation
   Table 19E: SMI Subpopulation
   Table 19F: HCBS Population Ages 18-64 Without I/DD or SMI
   Table 19G: HCBS Population Age 65+
 

The views expressed in this report are those of the authors and no official endorsement by the Agency for Healthcare Research and Quality or the Department of Health and Human Services is intended or should be inferred.