Online Program

Racial and ethnic variation in the use of home and community based services under Medicaid waiver 1915c

Monday, November 4, 2013 : 12:54 p.m. - 1:06 p.m.

Melanie Hinojosa, PhD, Department of Health Outcomes and Policy, University of Florida, Gainesville, FL
Elizabeth A. Shenkman, PhD, University of Florida, College of Medicine, Gainesville, FL
Background: Medicaid/Medicare has expanded coverage for home and community based services (HCBS) allowing members with disabilities to receive long-term care services in home, rather than institutional settings. Racial/ethnic minorities bear a greater burden of chronic illness compared to whites, yet little is known about how HCBS are utilized by racial/ethnic minorities or how services received are congruent with health needs. Objective: To survey participants receiving HCBS under a Medicaid 1915(c) waiver in the state of Texas for the purpose of a) describing and categorizing the types and cost of HCBS by race and ethnicity, and b) examining the association between health needs, depression, and demographic characteristics with services and costs. Method: A phone survey was conducted with 202 participants (32% white, 38% Latino, 23% Black, and 7% other) utilizing HCBS in 2012 (73% response rate). Data on HCBS utilized for each participant during 2012 was obtained from two Medicaid managed care organizations and merged with survey data. Results: Personal assistant services were the HCBS used most frequently (61%) followed by respite care (40.3%), nursing care (19%), emergency response services (13.5%), and medical supplies (7.0%). Black and Latino participants used fewer nursing services (F=3.4, p<.05) and medical supplies (F=3.8, p<.01) compared to whites. In adjusted models, Black (OR=.74, p<.05) and Latino (OR=.65, p<.05) participants used fewer services overall and had lower costs compared to whites while reporting higher psychological (F=4.0, p<.05) and social (F=3.1, p<.05). Cost of HCBS was also predicted by older age (OR=8.1, p<.05) and poorer health (OR=2.0, p<.05).

Learning Areas:

Other professions or practice related to public health

Learning Objectives:
Describe the type of home and community based services utilized by white, Latino, and Black Medicaid/Medicare members in Texas. Describe the association between health needs, depression, and demographic characteristics with home and community based service use and related costs.

Keyword(s): Ethnic Minorities, Medicare/Medicaid

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-investigator on multiple federal, state and foundation funded grants related to the following topics; health education, health behavior, caregiving, caregivers, mental and behavioral health outcomes and health care utilization. One area of research interest is in how home and community based services are utilized by elderly and disabled populations to develop interventions to better serve these groups.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3208.0: Medicare/Medicaid Policy