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Center for Health Policy & Research Page 1 Lobat Hashemi, MS (1) Raymond E. Glazier, Ph.D. (2) Frederick H. Hooven, MMHS (1) Jay Himmelstein MD, MPH (1)

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Presentation on theme: "Center for Health Policy & Research Page 1 Lobat Hashemi, MS (1) Raymond E. Glazier, Ph.D. (2) Frederick H. Hooven, MMHS (1) Jay Himmelstein MD, MPH (1)"— Presentation transcript:

1 Center for Health Policy & Research Page 1 Lobat Hashemi, MS (1) Raymond E. Glazier, Ph.D. (2) Frederick H. Hooven, MMHS (1) Jay Himmelstein MD, MPH (1) (1)Center for Health Policy & Research, University of Massachusetts Medical School (2)Abt Associates Inc. Contact for further info: lobat.hashemi@umassmed.edu 508-856-8525lobat.hashemi@umassmed.edu Medicaid Expenditures for Working and Non- Working Consumers Who Use Personal Assistance Services (PAS): The Massachusetts Experience Center for Health Policy & Research (chpr)

2 Center for Health Policy & Research Page 2 Personal Assistance Services (PAS) are felt to be a critical component in the continuum of community based long-term care services that allow people with disabilities to live and work in the community. Little information is available on the cost, utilization and impact of PAS services offered through Medicaid programs. Key questions include: -How much do PAS programs cost? -Does this cost differ for working disabled vis-à-vis non- working disabled individuals? -Does providing PAS services have an effect on the overall expenditures of the Medicaid program for these consumers? Background

3 Center for Health Policy & Research Page 3 Massachusetts has one of the first Medicaid programs in the country to pay for PAS services for working persons with disabilities. The program began in 1988. MassHealth (Medicaid) is the only health insurance plan in MA that covers PAS services. PAS services are Consumer-Directed: Consumers recruit, interview, hire, train and manage their Personal Care Attendants (PCA). Personal Assistance Services Program in Massachusetts

4 Center for Health Policy & Research Page 4 Who can receive PAS services? Eligibility criteria: MassHealth member. Chronic or permanent disability. Approved by Primary Care Physician. Need for physical assistance in two or more of the following activities of daily living: –Mobility, assistance with medication, bathing, dressing, range of motion, eating, toileting. Note: –No age restriction for receiving PAS services. –No limit on the number of PAS hours authorized. –Number of hours approved are based on functional status and household composition.

5 Center for Health Policy & Research Page 5 Previous studies In fiscal year 2002, almost 3% of the working disabled MassHealth members used PAS services, with an average cost of approximately $24,000 per year per member. During the same fiscal year, approximately 4% of the non-working disabled MassHealth members used PAS services, with an average cost of approximately $18,000 per year per member *. *Utilization of Personal Assistance Services (PAS) by Medicaid Consumers with Disabilities: The Massachusetts Experience. Hashemi, et al., Academy Health Conference, June 2003.

6 Center for Health Policy & Research Page 6 Research Question Do working PAS users have lower overall Medicaid expenditures than non-working PAS users? –When controlling for Functional status Other insurance coverage Demographic characteristics

7 Center for Health Policy & Research Page 7 Data source: Fiscal Year 2003 MassHealth claims and eligibility data. Study population: 1.MassHealth Disabled members between 18 and 64 in two MassHealth Plans: Standard Disabled (Non- working) or CommonHealth Working/Buy-in (Working). 2.Must have used at least one hour of PAS service during the fiscal year. Procedure codes were used to identify PAS claims. Methods

8 Center for Health Policy & Research Page 8 Standard Disabled (Non-working): Meets SSA disability criteria: Lower income only (based on income and family size) No work requirement No premium payments CommonHealth Working/Buy-In (Working): Meets SSA disability criteria: No income or asset limit 40 hour per month work requirement May pay a monthly premium based on income and family size Methods – Study Groups:

9 Center for Health Policy & Research Page 9 Methods - Analysis Univariate analysis was used to compare the overall Medicaid expenditures between the two populations. Multivariate analysis was used to control for functional status, other insurance coverage (Medicare or private), age and gender. - Functional status measure: Approved hours of PAS services.

10 Center for Health Policy & Research Page 10 Results: Demographics Working N=202 (2.3%) Non-working N=5,016 (3.8%) P-value Age - mean (+/-STD)49 (+/-10)44 (+/-13)<.0001 Males54%42%.0003 Race, white89%86%.5127 FPL, > 200%87%<1%<.0001 Other insurance: Medicare Private Medicaid only 36% 55% 9% 52% 10% 38% <.0001

11 Center for Health Policy & Research Page 11 Results WorkingNon-working Mean approved hrs/week5142 Mean used hrs/week3930 Ratio used/approved hrs.76.71 PAS hours approved vs. hours used * : Working PAS users are approved for more hours (suggesting lower functional status or greater need due to living arrangements) and use more of their approved hours compared to the Non- working PAS users. There was not a significant difference between the two population on the ratio of used/approved hours.

12 Center for Health Policy & Research Page 12 Results: Overall Medicaid Per Member Per Month Expenditures (PMPM ) $3,332 $2,694 There was a significant difference between the PMPM in each category shown above at P<.0001 PMPMPMPM Non-PAS PAS Non-PAS PAS $532 $1,922

13 Center for Health Policy & Research Page 13 Results VariableCoefficient% changeP-value Working -1.3895-74%<.0001 Other insurance -0.6234-46%<.0001 Gender (1 male) -0.1297-12%0.0006 Age 0.0017<.01%0.2604 Hours approved * -0.0095-<.01%0.7554 Dependent variable: Non-PAS expenditures Per Member Month * Non-PAS expenditures are 74% less in the working population compared to non-working, after controlling for presence of other insurance, functional status and demographic characteristics. *Natural log of non-PAS pmpm and hours approved were used.

14 Center for Health Policy & Research Page 14 Results VariableCoefficient % changeP-value Working -.2838 -25%<.0001 Other insurance-.2189-20%<.0001 Gender (1 male) -.0266-0.03%0.1620 Age -.0017-<0.01%0.0226 Hours approved * -.580244%<.0001 Dependent variable: Overall expenditures Per Member Month * *Natural log of non-PAS pmpm and hours approved were used. Overall expenditures are 25% less in the working population compared to non-working, after controlling for presence of other insurance, functional status and demographic characteristics.

15 Center for Health Policy & Research Page 15 The overall and non-PAS Medicaid expenditures were significantly lower among working PAS users than among non- working PAS users. This cost difference holds true even among those without other insurance, suggesting that lower Medicaid expenditures among the working disabled is not due to third party insurance alone. Conclusions

16 Center for Health Policy & Research Page 16 Study Limitations We can not rule out that unmeasured difference in severity of disability between the two groups had an effect on costs. We lacked a variable for household composition, which could have been different in the two populations, resulting in different numbers of hours approved in each group for household chores.

17 Center for Health Policy & Research Page 17 Policy Implications States who are planning to add a PAS benefit to their Medicaid programs should recognize that utilization and total costs may vary for working as compared to non-working populations. Further study of the impact of PAS services on health care utilization and system-wide economic impact are warranted.

18 Center for Health Policy & Research Page 18 Funding for this research provided by the Centers for Medicare and Medicaid Services (CMS) P-91234 - http://www.cms.hhs.gov Further information on the Massachusetts Medicaid Infrastructure grant and PAS/PCA services: –Massachusetts Medicaid Infrastructure Grant - http://www.massmig.orghttp://www.massmig.org –Massachusetts Division of Medical Assistance - http://www.state.ma.us/dma/ http://www.state.ma.us/dma/ –Independent Living Research Utilization - http://www.ilru.org/http://www.ilru.org/ –World Institute on Disability - http://www.wid.org/http://www.wid.org/ –Center for Living and Working - http://www.centerlw.org/http://www.centerlw.org/ Funding Source, Acknowledgments & Further Information


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