Objective: 

We examined characteristics associated with receiving the North Carolina Home and Community-Based Services Waiver for intellectual and developmental disabilities (I/DDs) and its association with emergency department (ED) utilization.

Method: 

Through analysis of the North Carolina 2017 to 2018 Medicaid claims and enrollment data, we examined characteristics (age, sex, race and ethnicity, geography, diagnosis (intellectual disability [ID] with or without autism spectrum disorders or autism spectrum disorder without ID) associated with receiving the NC I/DD Waiver and the association of this Wavier with ED utilization. We identified patients with at least 1 International Classification of Diseases-10-CM diagnosis code for an ID or autism spectrum disorder. We excluded patients with missing county information and whose enrollment in the NC I/DD Waiver program began after October 1, 2017.

Results: 

Only 22% of 53,531 individuals with I/DD in North Carolina received the Waiver. Non-Hispanic Blacks and Hispanic individuals were less likely to receive the Waiver than non-Hispanic White individuals. Adults (>21 years old), men, and urban residents were more likely to receive the Waiver. Individuals who received the Waiver were 31% less likely to use the ED.

Conclusion: 

Innovative strategies are needed to provide equitable access to the NC I/DD Waiver and provide services to the 14,000 people with I/DD currently waiting to receive the Waiver. Through the Waiver, those with I/DD can access preventative and therapeutic outpatient services and decrease their need for ED care. These findings highlight the need for policy reform to address inequities in access to the Waiver for individuals with I/DD.

中文翻译：

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智力障碍或自闭症谱系障碍患者在获得北卡罗来纳州医疗补助豁免方面的不平等

客观的： 

我们研究了与接受北卡罗来纳州智力和发育障碍 (I/DD) 家庭和社区服务豁免相关的特征及其与急诊室 (ED) 使用的关系。

方法： 

通过对北卡罗来纳州 2017 年至 2018 年医疗补助索赔和登记数据的分析，我们检查了相关特征（年龄、性别、种族和民族、地理位置、诊断（智力障碍 [ID] 伴或不伴自闭症谱系障碍或不伴 ID 的自闭症谱系障碍）获得 NC I/DD 豁免以及此豁免与 ED 使用之间的关联。我们确定了至少具有 1 个 ID 或自闭症谱系障碍的国际疾病分类-10-CM 诊断代码的患者。我们排除了缺少县信息的患者且其 NC I/DD 豁免计划的注册于 2017 年 10 月 1 日之后开始。

结果： 

北卡罗来纳州 53,531 名 I/DD 患者中，只有 22% 获得了豁免。非西班牙裔黑人和西班牙裔个人获得豁免的可能性低于非西班牙裔白人。成年人（>21 岁）、男性和城市居民更有可能获得豁免。获得豁免的个人使用 ED 的可能性降低了 31%。

结论： 

需要创新策略来提供公平获得 NC I/DD 豁免的机会，并为目前等待获得豁免的 14,000 名 I/DD 人士提供服务。通过豁免，患有 I/DD 的患者可以获得预防性和治疗性门诊服务，并减少对急诊护理的需求。这些发现强调需要进行政策改革，以解决患有 I/DD 的个人在获得豁免方面的不平等问题。