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Modeling the determinants of Medicaid home care payments for children with special health care needs: A structural equation model approach
Evidence abounds on the state variability and financial burden of raising children with special needs. We use Structural Equation Modeling (SEM) to estimate the effects of children’s strengths and needs on total expenditures for Medicaid home care.
Study Design:
We retrospectively assessed secondary data on children, ages 4–20, receiving Texas Medicaid Personal Care Services (PCS). All information about a child’s health status came from family caregiver responses recorded by a case manager or from a case manager’s observations of the child during the Medicaid assessment process. The study sample (n=2760) represented more than half of all children receiving and being evaluated for PCS in 2009. The major endogenous (dependent) variable in our analyses was Medicaid home care payments over a period of 6 months period in 2009, obtained from the Texas Medicaid claims data. Exogenous variables included several child characteristics, clinical conditions and functional measures.
Population Studied:
Children aged 4-20 with special needs
Principal Findings:
Approximately 60% of children were female with a mean age of 12.07 years. Almost half of all subjects reported mild, moderate or severe ID diagnosis. About 60% of subjects received some type of rehabilitation services. The mean ADL score was 5.27 and on average, children exhibited two behaviors directed out towards others. Caseworkers authorized an average of 25.5 hours of PCS support per week
The SEM revealed three elements with only indirect effects: Cognitive problems, health impairments, and age. All three affect expenditures, but they operate completely through other variables. Other elements accumulate effects (externalizing behaviors, PCS hours, and rehabilitation) and send them on a single path to the dependent variable. A few elements exhibit a relatively complex position in the model by having both significant direct and indirect effects on home care expenditures---medical conditions, intellectual disability, region, and ADL function.
Conclusions:
When one seeks the most important drivers of home care expenditures for children, they are among those elements that have both meaningful direct and indirect effects. Our findings indicate these drivers are medical conditions, intellectual disability, region and ADL function. The only one of these factors that may be within the sphere of policy manipulation is the difference among costs in different regions.
Learning Areas:
Biostatistics, economicsConduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public
Public health or related public policy
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health
Learning Objectives:
Assess direct and indirect effects of several child characteristics, clinical conditions and functional measures on Medicaid home care payments for children with special needs
Identify elements that only have direct or indirect effects on Medicaid home care payments
Identified elements that exhibit a relatively complex position in the model by having both significant direct and indirect effects on home care expenditures---medical conditions, intellectual disability, region, and ADL function. These are the most significant drivers of cost.
Keyword(s): Children With Special Needs, Long-Term Care
Qualified on the content I am responsible for because: I am a fourth-year PhD student in Health Services Research with a concentration in health economics. I have participated in several fedral and stated funded reserach projects, such as: Treating Obesity in Underserved Rural Areas Weight Control Program; P-20 Diabetes Self-Management; Effects of Children Case-mix Adjustments on Home Care Payments for Medicaid Personnel Care Services; EMCAP Capacities of VA Emergency Management and Evaluation; and the East Texas Medical Center Emergency Department Referral Evaluation project.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.