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Payment Rates for Personal Care Assistants and the Use of Long‐Term Services and Supports among Those Dually Eligible for Medicare and Medicaid
Author(s) -
Ko Michelle,
Newcomer Robert,
Kang Taewoon,
Hulett Denis,
Chu Philip,
Bindman Andrew B.
Publication year - 2014
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12249
Subject(s) - medicaid , payment , medicine , long term care , acute care , multinomial logistic regression , personal care , logistic regression , family medicine , emergency medicine , nursing , health care , business , finance , machine learning , computer science , economics , economic growth
Objective To examine the association between payment rates for personal care assistants and use of long‐term services and supports ( LTSS ) following hospital discharge among dual eligible Medicare and Medicaid beneficiaries. Data Sources State hospital discharge, Medicaid and Medicare claims, and assessment data on California Medicaid LTSS users from 2006 to 2008. Study Design Cross‐sectional study. We used multinomial logistic regression to analyze county personal care assistant payment rates and postdischarge LTSS use, and estimate marginal probabilities of each outcome across the range of rates paid in C alifornia. Data Extraction Methods We identified dual eligible Medicare and Medicaid adult beneficiaries discharged from an acute care hospital with no hospitalizations or LTSS use in the preceding 12 months. Principal Findings Personal care assistant payment rates were modestly associated with home and community‐based services ( HCBS ) use versus nursing facility entry following hospital discharge ( RRR 1.2, 95 percent CI : 1.0–1.4). For a rate of $6.75 per hour, the probability of HCBS use was 5.6 percent (95 percent CI : 4.2–7.1); at $11.75 per hour, 18.0 percent (95 percent CI : 12.5–23.4). Payment rate was not associated with the probability of nursing facility entry. Conclusions Higher payment rates for personal care assistants may increase utilization of HCBS , but with limited substitution for nursing facility care.