Effect of enhanced services in the home and community based Medicaid services waiver on risk of psychiatric hospitalization for youth

BACKGROUND: NYS OMH provides a Home and Community Based Services Medicaid Waiver (HCBS-Waiver) to children who are at risk of out-of-home placement. HCBS-Waiver consists of individualized care coordination and enhanced service components. The study hypothesis is that higher doses of enhanced services are associated with decreased risk of subsequent psychiatric hospitalization.

METHODS: Youth discharged from HCBS-Waiver services (N=4,994) were selected. Demographics, primary diagnosis, HCBS-Waiver services and subsequent psychiatric hospitalizations were extracted from OMH administrative data.

ANALYSIS: Relationships between each service type and the outcome were examined using independent log-rank tests. A Cox regression model was applied to compute the hazard ratio (HR) of being hospitalization for each enhanced service utilized, controlling for the length of waiver episode, demographics, and diagnosis at discharge.

RESULTS: An estimated 37% of children were hospitalized for psychiatric reasons within 3 years post Waiver discharge. Higher doses of skill building services were associated with decreased risk of hospitalization with a Hazard Ratio (HR) of 0.72 (95% 0.62-0.84). Both crisis response (HR: 1.44, 95% CI: 1.25-1.66) and respite services (HR: 1.23, 95% CI 1.06-1.42) were associated with increased risk of hospitalization. Mood disorder (HR=1.45, 95% CI=1.28-1.64) or schizophrenia (HR=2.46, 95% CI=2.03-2.99) were associated with an increased risk of hospitalization. Family support and intensive-in-home services were associated with reduced risk of hospitalization but the estimates were non-significant.

CONCLUSION: This study found that the enhanced service type provided during Waiver episodes had an effect on a child's risk of psychiatric hospitalization post HCBS-Waiver discharge.