Understanding dual enrollees' use of medicare home health services: The effects of differences in medicaid home care programs

OBJECTIVES. Both the Medicare and Medicaid programs have experienced consid erable growth in spending on home care in recent years. As policymakers ado pt measures (such as those legislated in the Balanced Budget Act of 1997) t o curb the rate of spending growth on home care services, it is important t o understand interactions between the Medicare and Medicaid home care progr ams in serving the dually enrolled population. This study examines the pote ntial effects of the Medicaid home care program on Medicare home health uti lization using multivariate models. METHODS. The study relied on data from the Health Care Financing Administra tion's Medicare Current Beneficiary Survey (MCBS), a longitudinal survey of Medicare enrollees. The primary MCBS file used was from Round I of the sur vey, which was fielded between September and December 1991. The unit of ana lysis was individuals. The authors used descriptive and multivariate method s to explore the relationship between Medicare coverage and state home care program characteristics. Included were variables that have been found to b e significant determinants of: Medicare home health utilization in other st udies as well as variables to indicate the availability and generosity of M edicaid home care services in each state represented in the survey. RESULTS. The findings were consistent with those of previous studies, in th at dual enrollees were disproportionate users of Medicare home health servi ces, accounting for only 16% of enrollees but receiving 40% of all visits. In addition, lower levels of Medicare home health use were observed in stat es with relatively higher Medicaid spending on home health and personal car e services, but this relationship appeared to be heavily dominated by the i nclusion of enrollees living in New York State. When individuals from New Y ork were excluded from the analysis, we found a negative but statistically significant relationship between Medicaid outlays on home health and person al care services and Medicare home health utilization. CONCLUSIONS. Because the Medicare and Medicaid programs are interconnected through the sizable dual enrollee population, changes in one program are li kely to have ramifications for the other. This study presents another step in exploring how the two programs interact and emphasizes the fact that cos ts can be shifted between the two programs as policy changes are made to co ntrol the rate of home care spending growth.