Modeling the determinants of Medicaid home care payments for children with special health care needs: A structural equation model approach |
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| Institution: | 1. Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Via Celoria 11, 20133 Milano, MI, Italy;2. IRCCS E. Medea Scientific Institute, Conegliano-Pieve di Soligo Research Centre, Via Costa Alta 37, 31015 Conegliano, TV, Italy;3. Division of Child-Neuropsychiatry, ASL Biella, Via Caraccio 24, 13900 Biella, BI, Italy;1. The Richard Stockton College of New Jersey, USA;2. University of Canterbury, New Zealand;3. Dongbei University of Finance and Economics, China;4. University of Minho, Portugal;1. University of Versailles St-Quentin, EA 2506 Santé-Environnement-Vieillissement Research Group, Sainte Perine Hospital, AP-HP, Paris, France;2. Department of Family Medicine, McGill University, Montreal, Quebec, Canada;3. Division of Geriatric Medicine, McGill University, Jewish General Hospital, Montreal, Quebec, Canada;4. Solidage Research Group on Frailty and Aging, McGill University – University of Montreal, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada;5. Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada;6. Department of Health Administration, University of Montreal, Quebec, Canada;1. Hull College of Business Administration, Georgia Regents University, Augusta, Georgia;2. Department of Radiology and Imaging, Medical College of Georgia, Georgia Regents University, Augusta, Georgia;1. Department of Psychological Sciences, Purdue University, United States;2. Department of Psychology, University of Maine, Maine Graduate School of Biomedical Sciences and Engineering, United States;3. VA San Diego Healthcare System, University of California, San Diego, United States;4. Department of Psychology, University of Texas, Austin, United States |
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| Abstract: | BackgroundThe management of children with special needs can be very challenging and expensive.ObjectiveTo examine direct and indirect cost drivers of home care expenditures for this vulnerable and expensive population.MethodsWe retrospectively assessed secondary data on children, ages 4–20, receiving Medicaid Personal Care Services (PCS) (n = 2760). A structural equation model assessed direct and indirect effects of several child characteristics, clinical conditions and functional measures on Medicaid home care payments.ResultsThe mean age of children was 12.1 years and approximately 60% were female. Almost half of all subjects reported mild, moderate or severe ID diagnosis. The mean ADL score was 5.27 and about 60% of subjects received some type of rehabilitation services. Caseworkers authorized an average of 25.5 h of PCS support per week. The SEM revealed three groups of costs drivers: indirect, direct and direct + indirect. Cognitive problems, health impairments, and age 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.ConclusionsThe most important drivers of home care expenditures are variables that have both meaningful direct and indirect effects. The only one of these factors that may be within the sphere of policy change is the difference among costs in different regions. |
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| Keywords: | Special needs children Medicaid PCS Health care expenditures |
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