Projects
Medicaid Home-and Community-Based Services (HCBS): Differences in Spending and Utilization
2023–2024
Project Overview
Objective
To address gaps in research on the differences in LTSS spending and utilization by subpopulations and enrollee characteristics and improve understanding of how these differences may relate to disparities in health outcomes.
Project Motivation
MACPAC recognizes the importance of stratifying LTSS user and expenditure data by demographic information and hopes the results can inform policies to improve access to Medicaid LTSS and promote equity.
Prepared For
Medicaid and CHIP Payment and Access Commission
Mathematica is using national Medicaid data to help the Medicaid and CHIP Payment and Access Commission (MACPAC) better understand how LTSS users and expenditures vary by service category, enrollee characteristics, and LTSS subpopulations.
The current analysis builds off MACPAC and Mathematica’s 2017 study of HCBS use and spending patterns for Medicaid fee-for-service (FFS) HCBS users and enrollee subgroups using the Medicaid Analytic extract (MAX) data. In the updated analysis, we use the T-MSIS Analytic File (TAF) data for all states from 2019 to 2021 and a broader definition of HCBS. The analysis compares user counts and expenditures by state, delivery system, Medicaid authority, updated HCBS taxonomy category, and enrollee characteristics such as age, race or ethnicity, geographic location, and Medicaid eligibility group. We also developed claims-based definitions for LTSS subpopulations.
In addition, the project will identify opportunities for further research and examine health outcomes for LTSS users in both institutional and community settings.
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