Increasing expenditures on home‐ and community‐based services: Do home care workers benefit?

作者：Katherine Miller, Norma B. Coe, Amanda R. Kreider, Allison K. Hoffman, Katherine Rhode, Pilar Goñalons-Pons · 发表于：Health Services Research · 年份：2024 · DOI：10.1111/1475-6773.14399 · 被引用次数：3 · 研究领域：Geriatric Care and Nursing Homes、Healthcare Policy and Management、Intergenerational Family Dynamics and Caregiving

OBJECTIVE: To examine the association of Medicaid home- and community-based services (HCBS) expenditures on the home care workforce. DATA SOURCES/STUDY SETTING: We use two national, secondary data sources from 2008 to 2019: state-level Medicaid HCBS expenditures and the American Community Survey, in which we identify direct care workers in the home (i.e., home care workers), defined as nursing, psychiatric, and home health aides or personal care aides working in home health care services, individual and family services, and private households. STUDY DESIGN: Our key explanatory variable is HCBS expenditures per state per year. To estimate the association between changes in Medicaid HCBS expenditures and the workforce size, hourly wages and hours worked, we use negative binomial, linear, and generalized ordered logit regression, respectively. All models include demographic and socioeconomic characteristics, the number of potential HCBS beneficiaries (individuals with a disability and income under the federal maximum income eligibility limits), indicators for minimum wage and/or overtime protections for direct care workers, wage pass-through policies, and state and year fixed effects. DATA COLLECTION/EXTRACTION METHODS: We exclude states with incomplete reporting of expenditures. PRINCIPAL FINDINGS: States' HCBS expenditures increased between 2008 and 2019 after adjusting for inflation and the number of potential HCBS beneficiaries. Yet, home care workers' wages remained stagnan...