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

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).