Medicaid Home and Community Based Services Spending and Nursing Home Use by Individuals Under the Age of 44.

Publisher: Sage Country of Publication: United States NLM ID: 0171671 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1945-7243 (Electronic) Linking ISSN: 00469580 NLM ISO Abbreviation: Inquiry Subsets: MEDLINE

Publication: Sept. 2013- : Thousand Oaks, CA : Sage
Original Publication: Chicago, Blue Cross Assn.

Nursing Homes*/statistics & numerical data ; Nursing Homes*/economics ; Medicaid*/economics ; Medicaid*/statistics & numerical data ; Health Expenditures*/statistics & numerical data ; Community Health Services*/economics ; Community Health Services*/statistics & numerical data ; Home Care Services*/economics ; Home Care Services*/statistics & numerical data; Humans ; United States ; Adult ; Adolescent ; Female ; Male ; Young Adult ; Child ; Child, Preschool ; Persons with Disabilities/statistics & numerical data

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Prior studies of the role of state spending on home and community-based services (HCBS) in nursing home use focused on adults over the age of 65. However, medically complex children and adults under 50 years old represent a small (about 5%) but highly vulnerable subset of nursing home patients. We measured the impact of HCBS spending on short-term and long-term nursing home stays by children and adults under 44 years old and compared the impact between Non-Hispanic White (NHW) individuals and Black, Indigenous, and People of Color (BIPOC). We used the Minimum Data Set to measure nursing home stays in each state per year in 2012 to 2019. The Medicaid Long Term Services and Supports annual expenditure reports were used to measure HCBS expenditures per state resident with a disability. Our outcome was nursing home use by children (<18 years old) and adults (18-43 years old) associated with a change in HCBS expenditures per state resident with a disability (measured in $1000 increments) estimated using linear regression. Higher HCBS expenditures per resident were associated with fewer short-term and long-term nursing home stays among NHW children. We did not find statistically significant association between changes in HCBS expenditures and nursing home stays among BIPOC children. Investments in HCBS are necessary to reduce nursing home use among younger adults. However, to mitigate racial disparities in nursing home use among children, HCBS spending alone may not be sufficient.

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R01 AG070944 United States AG NIA NIH HHS; R01 AG066841 United States AG NIA NIH HHS

Keywords: HCBS; children; nursing home; racial disparities; young adults

Date Created: 20250312 Date Completed: 20250512 Latest Revision: 20250605

20250605

PMC11898024

10.1177/00469580251323779

40071302