Research Paper
Personal care services provided to children with special health care needs (CSHCN) and their subsequent use of physician services

This work was presented (2012, June) as a poster entitled, “The effects of Medicaid personal care services on children's use of physician services” at the annual conference of AcademyHealth, Orlando, FL.
https://doi.org/10.1016/j.dhjo.2013.02.005Get rights and content

Abstract

Background

Medicaid Personal Care Services (PCS) help families meet children's needs for assistance with functional tasks. However, PCS may have other effects on a child's well-being, but research has not yet established the existence of such effects.

Objectives

To investigate the relationship between the number of PCS hours a child receives with subsequent visits to physicians for evaluation and management (E&M) services.

Methods

Assessment data for 2058 CSHCN receiving PCS were collected in 2008 and 2009. Assessment data were matched with Medicaid claims data for the period of 1 year after the assessment. Zero-inflated negative binomial and generalized linear multivariate regression models were used in the analyses. These models included patient demographics, health status, household resources, and use of other medical services.

Results

For every 10 additional PCS hours authorized for a child, the odds of having an E&M physician visit in the next year were reduced by 25%. However, the number of PCS hours did not have a significant effect on the number of visits by those children who did have a subsequent E&M visit. A variety of demographic and health status measures also affect physician use.

Conclusions

Medicaid PCS for CSHCN may be associated with reduced physician usage because of benefits realized by continuity of care, the early identification of potential health threats, or family and patient education. PCS services may contribute to a child's well-being by providing continuous relationships with the care team that promote good chronic disease management, education, and support for the family.

Section snippets

The sample and data collection

Almost all of the independent variables were constructed based on data collected during regularly scheduled evaluations of the needs of children seeking or receiving PCS. The exception is a binary measure from the claims data indicating whether the child participated in the Medicaid Primary Care Case Management (PCCM) program. The Personal Care Assessment Form (PCAF)17, 18 for children 4–20 years of age was used for the assessments, which were completed by Texas DSHS case managers in Texas's 11

Results

Table 1 presents descriptive data on the independent variables used in the analyses; a summary of the significant variables from the regression models follows. In terms of demographic characteristics, 38.3% of the children in the analytic sample were ages 4–9 years and 36.2% were ages 10–15 years, while 11.3% were 16–17 years old, and 14.2% were 18–20 years old. Almost 17% of the children lived in a rural area, and half (51.1%) of the children were in HSR 11.

The health status variables depicted

Discussion

To our knowledge, this is the first study to examine the impact of Medicaid PCS on the subsequent physician services for CSHCN. Understanding the home-based needs of these children and their families, payment for health services, and issues related to subsequent costs is essential to developing informed policy that strategically allocates resources and services for these individuals.30, 31 This is especially an issue for children in the EPSDT program. They often receive multiple services, and

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