Evaluation of a Home and Community-Based Waiver for Persons with Aids. Abstract,211 Executive Summary, Final Report

摘要

State Medicaid home and community-based waiver programs for persons with AID211u001e(PWAs) were implemented with the expectation that PWAs would use home and 211u001ecommunity-based services in lieu of more expensive hospital-based care. If so, 211u001ethen Medicaid spending per PWA should decline and this in turn should generate 211u001eprogram cost savings. While a few published studies have found this to be the 211u001ecase, they are based on data which pre-dates the development of highly effective 211u001ebut expensive antiretroviral combination therapies. Iin this study, we analyzed 211u001eFlorida Medicaid claims data for PWAs from December 1993 through December 1997 to 211u001edetermine how participation in the home and community based waiver affects the 211u001euse of services, monthly expenditures and survival of PWAs. Our descriptive 211u001eanalyses show that monthly expenditures are almost $843 or 42% higher for non-211u001eparticipants than for those enrolled in the waiver. These differences persist 211u001eacross demographic groups. From the multivariate analyses of 1996-1997 period 211u001eduring which combination drug therapy was an available treatment for Medicaid 211u001epatients with HIV or AIDS, we find that the selection of the waiver is not 211u001erandom. White men and sicker patients are more likely to participate in the 211u001ewaiver than other groups. Controlling for the non-random selection of the waiver, 211u001ewe find that: (1) waiver participants are more likely to receive combination 211u001etherapy and are less likely to use inpatient care relative to non-participants; 211u001e(2) monthly Medicaid expenditures are 49% lower for those enrolled in the waiver 211u001ecompared to nonenrollees; and (3) waiver participation does not significantly 211u001eaffect survival. Overall, the Florida Medicaid AIDS waiver (Project AIDS Care) 211u001eseems to be an efficient treatment option.