A model assessment for surveillance of disease prevalence and monitoring cost utility and health outcomes of individuals with physical disabilities served by HCBS waivers

Medicaid-funded Home and Community Based Services (HCBS) waivers provide coverage for community services that help minimize loss of function in areas of daily living (e.g., ADLs/IADLs) that directly affect health status and, by association, the ability to fully participate in the community. By providing these services, HCBS waivers enable people with various disabilities and substantial long-term care needs to remain in the community (Allen & Mor, 1997; Cope, 2006; LeBlanc et al., 2000). In order to monitor, improve, and build a case for continuing their programs, Medicaid and HCBS program managers must have a clear understanding of health care utilization and expenditures for this population (Powers, 2005).

Nevertheless, little is known about how HCBS waiver services affect the health utilization of the recipients (Fox & Kim, 2004). In addition, only a modest amount of information is available about the health and health care utilization patterns of individuals with physical disabilities supported by Medicaid (Fox & Kim, 2004; Long et al., 2002; Shinogle & Wiener, 2006).

The purpose of this session is to describe a model using claims data that state Medicaid programs can employ to monitor cost utility and health outcomes of individuals with physical disabilities served by HCBS waivers.