Thursday, August 24, 2023
2:00 - 3:00 pm
Eastern Time
Out of the Woodwork? Medicaid Home and Community-based Services Spending for Older Adults
Speakers: Brian McGarry and David Grabowski
ABOUT THE TOPIC:
Although older adults prefer to age at home, Medicaid has a longstanding institutional bias in funding long-term services and supports (LTSS). Some states have resisted expanding Medicaid funding for home- and community-based services (HCBS) due to budgetary concerns related to the so-called “woodwork” effect whereby individuals enroll on Medicaid to access HCBS.
To examine the implications associated with state Medicaid HCBS expansion, the authors compared outcomes in states that expanded Medicaid HCBS aggressively versus those that expanded less aggressively. They explored a range of outcomes including Medicaid enrollment, nursing home census, Medicaid institutional LTSS spending, total Medicaid LTSS spending, and Medicaid HCBS waiver enrollment.
The authors found that HCBS expansion was not associated with increased Medicaid enrollment – the so-called woodwork effect -- among individuals ages 65 and older. Increased HCBS waiver spending was associated with more older adults receiving LTSS at a lower cost per beneficiary served relative to the nursing home setting. Moreover, these states experienced Medicaid savings from reduced nursing home use, suggesting states that expand Medicaid HCBS are able to use these additional dollars to serve more LTSS recipients.
Their article can be found here:
https://agsjournals.onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.18478
ABOUT THE SPEAKERS:
Brian E McGarry, PT, PhD
Brian McGarry is an assistant professor in Medicine at the University of Rochester Medical School. He is a physical therapist and health services researcher with an interest in the economics of aging. His research focuses on older adults' navigation of the Medicare program and long-term care system, as well as the impact of public policies on the cost and quality of care delivered to older adults. He completed his PhD in Health Services Research at the University of Rochester School of Medicine and Dentistry and a postdoctoral fellowship in Health Economics and Policy at Harvard Medical School.
David C Grabowski, PhD
David Grabowski is a professor of health care policy in the Department of Health Care Policy at Harvard Medical School. His research examines the economics of aging with a particular interest in the areas of long-term care and post-acute care. He has published over 220 peer-reviewed articles. From 2017 through 2023, Dr. Grabowski was a member of the Medicare Payment Advisory Commission (MedPAC). He has also served on several CMS technical expert panels. Grabowski received his BA from Duke University and his PhD in public policy from the Irving B. Harris School of Public Policy at the University of Chicago.
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