ABSTRACT

This study examines the relationship between two state Medicaid home and community-based services (HCBS) policies – number of beneficiaries (Participation) and use per beneficiary (Intensity) – and individual health expenditures. Data include the 2008–2013 Medicare Current Beneficiary Survey and state-level Medicaid HCBS indicators. Two-part generalized linear models are estimated for health expenditures by payer and dual-eligibility status. The likelihood and level of Medicare expenditures are significantly lower in states in the top quartile of Participation and Intensity. Findings suggest that state Medicaid HCBS policies may impact health expenditures, with potential spillover effects on Medicare spending.

摘要

本研究调查了两个州的医疗补助家庭和社区服务 (HCBS) 政策之间的关系——受益人数量（参与）和每个受益人的使用（强度）——与个人健康支出。数据包括 2008-2013 年医疗保险当前受益人调查和州级医疗补助 HCBS 指标。两部分广义线性模型按付款人和双重资格状态估计卫生支出。在参与度和强度排名前四分位数的州，医疗保险支出的可能性和水平明显较低。调查结果表明，州医疗补助 HCBS 政策可能会影响医疗支出，并可能对医疗保险支出产生溢出效应。