Racial disparities in Medicaid home and community-based service utilization and expenditures among persons with multiple sclerosis

Chanee D Fabius,Kali S Thomas,Tingting Zhang,Jessica Ogarek,Theresa I Shireman

doi:10.1186/s12913-018-3584-x

Abstract

BackgroundMedicaid home and community-based services (HCBS) provide services such as personal care, nursing, and home-delivered meals to aging adults and individuals with disabilities. HCBS are available to people across racial and ethnic groups, yet racial disparities in Medicaid HCBS utilization and expenditures have been understudied. Individuals with multiple sclerosis (MS) may be particularly impacted by HCBS, as nearly one-third requires assistance at home. The present study examined whether disparities exist in Medicaid HCBS utilization and expenditures among HCBS users with MS.MethodsWe used secondary data to conduct a retrospective cohort analyses including 7550 HCBS recipients with MS. Demographic data was obtained from the Medicaid Analytic eXtract Personal Summary file, Medicaid HCBS service utilization and expenditures were obtained from the Other Therapy file, and comorbidities from the Medicare Chronic Condition Warehouse. Univariate and bivariate statistics were used to describe the sample and provide comparisons of characteristic by race. Logistic regression predicted the likelihood of using HCBS type and gamma regression was used to predict Medicaid HCBS expenditures.ResultsBlack HCBS users were younger, more likely to be female, and were more impaired than Whites. Multivariate analyses showed that Blacks were less likely to receive case management, equipment, technology and modification services, and nursing services compared to Whites. Additionally, Black men had the lowest Medicaid HCBS expenditures, while White men had the highest.ConclusionsFindings shed light on disparities among HCBS users with MS. As Blacks are already disproportionately affected by MS, these results reveal target areas for future research. Future work should examine the factors that contribute to these disparities, as well as determine the extent to which these inequities impact outcomes such as hospitalizations and nursing home admissions.

Highlights

Medicaid home and community-based services (HCBS) provide services such as personal care, nursing, and home-delivered meals to aging adults and individuals with disabilities
Persons with multiple sclerosis (MS) are forced to leave the workforce prematurely, further comprising their financial stability [7]. The confounding of these factors – declining health and increasing functional and financial need – puts people with MS at further risk of nursing home placement [8]. These risks might be mitigated by the use of HCBS, which have been found to reduce the use of long-stay nursing home care [9]
Black HCBS users were younger, more often female, and had higher rates of heart failure, diabetes, hypertension, and mobility impairment compared to Whites

Summary

Introduction

Medicaid home and community-based services (HCBS) provide services such as personal care, nursing, and home-delivered meals to aging adults and individuals with disabilities. HCBS provide assistance to people across disabilities, ages, races, and ethnicities, yet racial disparities in services have been understudied, and findings have often produced conflicting results. The confounding of these factors – declining health and increasing functional and financial need – puts people with MS at further risk of nursing home placement [8]. These risks might be mitigated by the use of HCBS, which have been found to reduce the use of long-stay nursing home care [9]

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Results

Discussion

Conclusion