Differences in Waiver Services and Healthcare Utilization Outcomes among Adults with Disabilities

Through recent decades, state authorities have been progressively promoting Medicaid Home and Community–Based Services (HCBS) as an alternative to institutionalization. Despite continued growth in HCBS, additional understanding is necessary about the frequency of waiver services and healthcare utilization outcomes within this population. The study examined the associations of the structural determinants of health (age, race/ethnicity, gender, and regions) and the intermediary determinants of health (health conditions and HCBS programs) with the frequency of homemaker, personal assistant/attendant care, adult day service, and Personal Emergency Home Response services and four healthcare utilization outcomes (hospital admissions, emergency department, ambulatory/preventive care services, and long-term care admissions) in a fee-for-service system. Moreover, the study explores the associations of frequency of waiver services and how the interaction with determinant factors affects hospital admissions, emergency department visits, ambulatory/preventive care visits, and long-term care admissions. The study also assessed whether the frequency of waiver services and healthcare utilization outcomes among Medicaid Managed Care participants differ from those individuals who remained in a fee-for-service system. It further explored the participants’ likelihood of utilizing specific waiver services and healthcare utilization outcomes according to Medicaid fee-for-service or managed care systems, as well as the characteristics associated with their utilization. The analyses indicated that the structural and intermediary determinants of health affect the variation of waiver service hours and healthcare utilization outcomes within this population. The data also suggests that the variation in the frequency of waiver services is also associated with healthcare utilization outcomes with and without interaction terms with the social determinants’ factors. Moreover, compared with fee-for-service recipients, individuals enrolled in a Medicaid-managed care system are more likely to receive greater frequencies of waiver services. Findings regarding Medicaid managed care transition versus fee-for-service suggested better utilization of ambulatory/preventive care services among individuals enrolled in the Medicaid managed care program.