000012451 001__ 12451
000012451 005__ 20240614041147.0
000012451 02470 $$ahttps://doi.org/10.1111/1475-6773.14325$$2doi
000012451 037__ $$aTEXTUAL
000012451 037__ $$bArticle
000012451 041__ $$aeng
000012451 245__ $$aThe role of Medicaid home- and community-based services in use of Medicare post-acute care
000012451 269__ $$a2024-05-28
000012451 336__ $$aArticle
000012451 520__ $$a&lt;p&gt;Objective: Medicaid-funded long-term services and supports are increasingly provided through home- and community-based services (HCBS) to promote continued community living. While an emerging body of evidence examines the direct benefits and costs of HCBS, there may also be unexplored synergies with Medicare-funded post-acute care (PAC). This study aimed to provide empirical evidence on how the use of Medicaid HCBS influences Medicare PAC utilization among the dually enrolled.&lt;/p&gt; &lt;p&gt;Data sources: National Medicare claims, Medicaid claims, nursing home assessment data, and home health assessment data from 2016 to 2018.&lt;/p&gt; &lt;p&gt;Study design: We estimated the relationship between prior Medicaid HCBS use and PAC (skilled nursing facilities [SNF] or home health) utilization in a national sample of duals with qualifying index hospitalizations. We used inverse probability weights to create balanced samples on observed characteristics and estimated multivariable regression with hospital fixed effects and extensive controls. We also conducted stratified analyses for key subgroups.&lt;/p&gt; &lt;p&gt;Data extraction methods: The primary sample included 887,598 hospital discharges from community-dwelling duals who had an eligible index hospitalization between April 1, 2016, and September 30, 2018.&lt;/p&gt; &lt;p&gt;Principal findings: We found HCBS use was associated with a 9 percentage-point increase in the use of home health relative to SNF, conditional on using PAC, and a meaningful reduction in length of stay for those using SNF. In addition, in our primary sample, we found HCBS use to be associated with an overall increase in PAC use, given that the absolute increase in home health use was larger than the absolute decrease in SNF use. In other words, the use of Medicaid-funded HCBS was associated with a shift in Medicare-funded PAC use toward home-based settings.&lt;/p&gt; &lt;p&gt;Conclusion: Our findings indicate potential synergies between Medicaid-funded HCBS and increased use of home-based PAC, suggesting policymakers should cautiously consider these dynamics in HCBS expansion efforts.&lt;/p&gt;
000012451 536__ $$oNational Institute on Aging$$c1RF1AG069857
000012451 540__ $$a&lt;p&gt;© 2024 The Author(s)&lt;/p&gt; &lt;p&gt;This is an open access article under the terms of the &lt;a href="http://creativecommons.org/licenses/by-nc-nd/4.0/" target="_blank"&gt;Creative Commons Attribution-NonCommercial-NoDerivs License&lt;/a&gt;, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.&lt;/p&gt;
000012451 542__ $$fCC BY-NC-ND
000012451 6531_ $$adual eligible
000012451 6531_ $$ahome‐ and community‐based services
000012451 6531_ $$along‐term care
000012451 6531_ $$apost‐acute care
000012451 690__ $$aBiological Sciences Division
000012451 691__ $$aPublic Health Sciences
000012451 7001_ $$1https://orcid.org/0000-0002-6453-5149$$2ORCID$$aWang, Sijiu$$uUniversity of Chicago
000012451 7001_ $$1https://orcid.org/0000-0003-3435-4221$$2ORCID$$aWerner, Rachel M.$$uUniversity of Pennsylvania
000012451 7001_ $$1https://orcid.org/0000-0003-1228-0938$$2ORCID$$aCoe, Norma B.$$uUniversity of Pennsylvania
000012451 7001_ $$aChua, Rhys$$uUniversity of Chicago
000012451 7001_ $$aQi, Mingyu$$uUniversity of Chicago
000012451 7001_ $$1https://orcid.org/0000-0003-3016-1318$$2ORCID$$aKonetzka, R. Tamara$$uUniversity of Chicago
000012451 773__ $$tHealth Services Research
000012451 8564_ $$yArticle$$9a7980a79-0b97-497b-80cb-63c64854f989$$s1165354$$uhttps://knowledge.uchicago.edu/record/12451/files/Role-of-Medicaid-home-and-community-based-services-in-use-of-Medicare-post-acute-care.pdf$$ePublic
000012451 8564_ $$ySupporting Information$$9c473e9c8-7360-4966-a6c1-b0393c18f344$$s460085$$uhttps://knowledge.uchicago.edu/record/12451/files/hesr14325-sup-0001-supinfo.docx$$ePublic
000012451 908__ $$aI agree
000012451 909CO $$ooai:uchicago.tind.io:12451$$pGLOBAL_SET
000012451 983__ $$aArticle