Center on Population Health and Aging
Pilot Projects
Pilot Project 3: The Effect of State Home Care Policy on Unmet Need for Personal Care
Peter Kemper (PI), Pamela Farley Short, and Dennis Shea
Specific Aims
States have greatly increased Medicaid home and community-based service (HCBS) programs in recent years. In 2002, almost $5 billion, 30 percent of the Medicaid long-term care expenditures, were spent on HCBS, an increase by 530 percent since 1990 (Eiken and Burwell, 2003). Whether to provide optional HCBS and how to operate HCBS programs are left to states' discretion. As a result, we observe wide variations across states, with the HCBS expenditures ranging from $50 million in Nevada to $5 billion dollars in New York in 2002 (Eiken and Burwell, 2003). These cross-sectional and longitudinal variations provide a series of natural experiments that permit analysis of the relationship between the generosity of state Medicaid HCBS policies and unmet need. The proposed pilot study is an initial step in what we anticipate will be a series of studies that exploit these natural experiments to understand the effect of state long term care policies on access to care, substitution of formal and informal care, the mix of community and institutional care, and the cost of care.
The overall aim of the proposed initial pilot study is to understand the extent of unmet need for personal care and the factors associated with it. The specific aims are:
- To document the prevalence of unmet for long term care need among Medicare beneficiaries with disability living in the community.
- To document trends in the prevalence of unmet need from 1992 to 2000.
- To describe the relationship between unmet need and population subgroups of individuals with disabilities.
- To describe the relationship between unmet need and the generosity of state HCBS programs.
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