R-3 Background: HCBS Waiver: Economic Utility and Related Health Outcomes

Overview
No studies have looked at how effective Home and Community-Based Services (HCBS) programs are when people move from institutional to community settings. For a more detailed literature review, click here

Purpose
The study purpose is to create a method for state Medicaid programs to measure how well their HCBS funds keep people with disabilities healthy and at what cost.

Anticipated Benefits

• Measure the success of the HCBS waiver use in Kansas in appropriate use of health care services

• Improve understanding of whether HCBS waivers differentially affect health care use of people who have lived in care facilities versus those who have not

• Improve understanding of HCBS waiver use in influencing the health of people with disabilities, which, in turn, influences community participation

State policymakers can use the method’s findings to make appropriate changes in their HCBS program, especially the ones needed to keep people with disabilities healthy. Consumers and their advocates, too, can use the findings to ensure the quality, quantity, and contents of state HCBS services.

Hypotheses
Healthcare use and costs will decrease for individuals with physical disabilities who move into a community using the HCBS waivers or who enroll for HSBS waivers while living in the community.

1) Individuals who have physical disabilities who move into a community using the HCBS waiver or who enroll for HSBS waivers while living in the community will have less health complications.

2) The amount of community participation of individuals with physical disabilities influences their health care use and costs.

3) The extent of health care need and use of individuals with physical disabilities influences their participation in their communities.

Study Design
During phase one, the Kansas Medicaid Program will provide data on all individuals with physical disabilities who used HCBS waiver during 2004 or 2005. Researchers will compare and contrast those who lived in institutional settings immediately prior to this time to individuals with physical disabilities who never lived in an institution but who used HCBS waivers in 2004 or 2005. Besides demographics, information gathered will include use and costs of primary care, outpatient care, inpatient care, home health care, prescription drugs, and HCBS waivers. Prevention and performance measures will include the use of emergency rooms, avoidable hospital conditions such as pneumonia, and secondary health conditions such as urinary tract infections.

In phase two, investigators will analyze the success of the Kansas HCBS program in a retrospective cohort analysis of four, one-year time periods in a row. This analysis will include descriptive statistics, Chi2 tests, t-tests, and multivariate models.

The relationship between community participant and health care service use and costs will be done in phase three. Their relationships will be determined by the PARTS/FABS. Two representative groups with 51 members each will participate. For a more detailed description, click here.
 

“Since waivers have been shown to affect healthcare utilization and expenditures of its beneficiaries, the research products will have significant implications for policy and practice at the state level.” Amanda Reichard, Ph.D.
Find out about the project's surprising start from Reichard.
Listen to Reichard excerpt.

"The state of Kansas received a $37 million dollar, five-year grant to facilitate people moving from institutional settings. With this opportunity, we believe that the research we are involved with will play a major role with helping SRS [Social Rehabilitation Services] and the Department of Aging assess the success of their movement to the community."
Read more from Martha Hodgesmith, J.D., interview.
Listen to Hodgesmith excerpt.

More Information

Deinstitutionalization
Both a policy and a practice, this movement that began in the 1960s has reduced the number of people living in state-operated institutions and increased the number of people needing support to live in their communities.

Functional ability
How well a person can perform activities of daily living without help from someone else constitutes a measure of their functioning.

Home and Community-Based Services (HCBS) Waiver Program
In 1981, legislation was passed to fund the HCBS program, which allows states to use Medicaid funds to pay for home and community services for Medicaid-eligible individuals who have disabilities. States must show that these individuals are at risk of being placed or remaining in institutions without these waiver-provided services. Additional legislation has provided Community Supported Living Arrangements for Medicaid-eligible persons with mental retardation and/or developmental disabilities that does not require the person to be at risk of institutionalization.

Olmstead decision
The 1999 U.S. Supreme Court Olmstead v. L.C. ruling reinforced the Americans With Disabilities Act stance on institutionalization of people with disabilities. The ruling made it discriminatory to keep someone in an institution if the person wanted to live in the community with appropriate services. It also promoted the practice of people with disabilities living in the "most integrated setting," which the U.S. Department of Justice defines as a setting that makes it easier for people with disabilities to interact with non-disabled people to the fullest extent.

Secondary conditions
This term typically has been used in a medical context to describe physiological conditions that can result from an original illness or condition. For example, people with spinal cord injuries are at risk for the secondary conditions of pressure sores, urinary tract infections, and deconditioning. The Healthy People 2010 Report expands secondary conditions to include social, emotional, family, or community problems that a person with a primary disabling condition may experience.

For online information, visit
Social Security Administration
Olmstead Decision: Federal Initiatives
Home and Community-Based Services Resource Network
New Freedom Initiative

For more information, contact Amanda Reichard, Ph.D., reichard@ku.edu; Martha Hodgesmith, J.D., marthah@ku.edu; or the Research and Training Center on Measurement and Interdependence in Community Living at the RTC/IL, 4089 Dole, 1000 Sunnyside Avenue, Lawrence, KS 66045, 785.864.4095 (voice), 785.864.0706 TTY, RTCIL@ku.edu
National Institute of Disability Rehabilitation Research grant H133B060018