Study Looks at Seniors Who Opt Out of Connecticut Medicaid Home and Community-Based Care Program

Resource use by non-participants in Connecticut's Medicaid home and community based waiver program

Researchers at the Urban Institute under the direction of Korbin Liu, ScD, and Sharon K. Long, PhD, studied how low-income, older adults in Connecticut who are disabled were managing their long-term care needs after they chose not to participate in, or were excluded from, the state's Medicaid's home and community-based care program.

The project was part of the Robert Wood Johnson Foundation (RWJF) Home Care Research Initiative national program.

The researchers compared 336 nonparticipants with 1,354 participants in Connecticut's Medicaid home and community-based care program. The researchers also conducted an analysis of the impact of the Balanced Budget Act of 1997 (BBA) on Medicare home health utilization. And they studied the impact of the BBA's home health provisions on the interaction between Medicare and Medicaid home care in Connecticut.

Key Findings

  • Participants and non-participants in Connecticut's Medicaid home and community-based care program were very similar in most demographic and health status characteristics. Although participants and non-participants were equally likely to use Medicare home health services, the non-participants were more likely (12.8%) to be admitted to nursing homes than participants (6.1%) within six months of program assessment.

  • Non-participants in Connecticut's home and community-based care program offered many reasons for not participating, including concerns about Medicaid estate recovery, preference for other ways to meet long-term care needs and the belief that they would not meet financial eligibility requirements.

  • Few subgroups in Connecticut were disproportionately affected by BBA policies. People with more activities of daily living (ADL) limitations received disproportionately fewer visits than those without such limitations.

  • Some home health agencies in Connecticut closed or merged with others because of the change in the Medicare payment structure resulting from the BBA. Many agencies reduced staff and benefits and scaled back overhead.

  • The number of referrals to the Connecticut Medicaid home and community-based care program increased by 40 percent after the passage of the BBA.

Researchers published articles about the project in Home Health Care Services Quarterly and Health Care Financing Review; another has been accepted by the Journal of Aging & Social Policy.