Background:
Identifying people at risk of entering nursing homes and connecting them with the home and community-based services they need could reduce long-term care spending.
Design:
The authors used a longitudinal, quasi-experimental research design that used propensity score matching to create a comparison group. 919 Medicaid recipients served by the Community Connector Program for three years (2005-08) in three counties, was observed before and after program enrollment and compared with a statistically matched, contemporaneous group of 944 recipients located in five nearby counties. Difference-in-difference analysis was used to assess changes in Medicaid spending for program participants before and after the intervention. Those estimates were compared with changes in spending observed in the matched comparison group.
Setting:
Monroe, Lee, and Phillips counties in Arkansas.
Participants:
Medicaid-eligible older adults and younger adults with physical disabilities who had potential unmet long-term care needs.
Intervention:
The Arkansas Community Connector Program used specially trained community health workers to identify people living in the community who have unmet long-term care needs and who may be at risk for entering nursing homes and connect them to Medicaid home and community-based services.
Measurements:
Annual measures for use of Medicaid services and spending for inpatient and outpatient medical services, nursing home services, home and community-based services, and other services were constructed from 2005–09 Medicaid records for each member of the intervention and comparison groups, and for each year before and after enrollment.
Results:
Program participants had 23.8 percent lower average annual Medicaid spending per participant from 2005–08 than a similar group of Medicaid recipients who did not participate in the program. Net three-year savings to the Arkansas Medicaid program equaled $2.619 million. The intervention group had significantly increased spending for home health and home and community-based services relative to the comparison group, and the comparison group had significantly increased spending on nursing homes services than the intervention group.
Conclusion:
Similar interventions may help other areas achieve cost-saving and equitable access to publicly funded long-term care options other than institutional care.