Assessing the Health and Welfare of the HCBS Population


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.

We present the outcome indicators 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.

All analyses are based on the 2005 Medicaid population as captured in the Medicaid Analytic eXtract (MAX) dataset (Centers for Medicare & Medicaid Services [CMS], 2010a). These data were merged with Medicare Provider Analysis and Review (MedPAR) files (CMS, 2010c) for the segment of the Medicaid population that was dually eligible for Medicare and Medicaid. In our analysis, we describe the Medicaid HCBS population nationally and for each State; however, pending further development and testing of the outcome indicators and potential addition of risk adjustment, we report outcome indicators and their relationship to individual, area, and State policy attributes only nationally.

This report has five sections:

  • Our approach to defining the HCBS population and four main subpopulations, followed by our findings in terms of characteristics of HCBS recipients.
  • Availability and use of Medicaid HCBS services, including both State plan and waiver services.
  • Hospital admission outcome indicators used in this report to assess the health and well-being of the HCBS population.
  • Rates of outcome indicators for the HCBS population by various personal and policy contextual attributes of potential interest, including by HCBS subpopulation, demographics, service availability and use, State Medicaid policy environment, area-level age and race, socioeconomic status, supply of health care providers, and area-level health characteristics of the population.
  • Conclusions.

The main body of the report (including references) is followed by a technical appendix, which describes the data sources used and the source and detailed definition of each variable used in the report.

Page last reviewed December 2012
Page originally created December 2012
Internet Citation: Introduction. Content last reviewed December 2012. Agency for Healthcare Research and Quality, Rockville, MD.
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