Browsing by Author "Baggett, Sharon"

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    Characterizing Home and Community-Based Service Enrollees in Minnesota’s Medicaid Waiver Program
    (Oxford University Press, 2022-12-20) Blackburn, Justin; Baggett, Sharon; Burton, Ellen; Snyder, Yonda; Health Policy and Management, School of Public Health
    Medicaid waivers allow states’ provision of home and community-based services (HCBS), leading to variations in design and delivery. States monitor expenditures, but cannot easily anticipate growth. Understanding the needs of this population can aid in early identification and improve service delivery. We conducted a Partitioning Around Medioids cluster analysis of first-time enrollees in Minnesota’s Elderly Waiver HCBS program during 2019 to identify trajectories of entry and characterize activities of daily living (ADL) and instrumental activities of daily living (IADL) needs at enrollment. Administrative data collected via long term care consultation assessments provided enrollment, ADL/IADL needs, living arrangements, and other clinically relevant information that was linked to other sources including Minnesota health care program enrollment and utilization, Minimum Data Set skilled nursing facility (SNF) assessments, and calls to the Senior LinkAge Line (SLL)—a free long-term care counseling service. Of 5,284 first-time enrollees, most had prior engagement with state programs—nearly two-thirds had called the SLL, 36% had a SNF stay, and 56% had prior Medicaid enrollment. We identified six clusters representing three levels of living arrangements and two levels of need: 1) lived alone, low needs (32%), 2) lived with others, moderate needs (20%), 3) congregate living, moderate needs (14%), 4) congregate living, high needs (14%), 5) lived with others, high needs (11%), and 6) lived alone, high needs (9%). Lacking caregivers and prior Medicaid were possible exacerbating reasons for HCBS enrollment. The magnitude of the differences between clusters highlights the constellation of factors leading to enrollment in HCBS.
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    Understanding Spenddown to Medicaid in Assisted Living: Survey Results from Participants/Representatives in Minnesota
    (Oxford University Press, 2022-12-20) Baggett, Sharon; Burton, Ellen; Blackburn, Justin; Health Policy and Management, School of Public Health
    The state of Minnesota has seen substantial growth in the use of Medicaid in Assisted Living and wanted to better understand how applicants spend down to Medicaid in order to identify potential upstream interventions to prolong the spend down period. As part of a mixed methods research effort, 231 new Medicaid participants or their proxies, 167 in AL and 64 at home, completed a telephone survey on their services use prior to Medicaid application, prior planning or thinking of how to pay for services once personal resources were exhausted, and experience of spenddown once in AL. Reaching these eligible participants required a unique, multi-step outreach process; given the abilities of participants to respond, the majority of surveys were completed by proxies. Among those in AL, 40% reported planning in advance about how to pay for services once needed; 58% knew of government programs to assist and 80% reported their plan included applying to the programs at some time. Thirteen percent (13%) of those in AL reported getting help from the Medicaid waiver at the time of move in; another 25% said they paid for themselves for less than one year before getting state support. More than one-third (34%) who paid for their services for some period of time after move in said the period was shorter than expected; another 41% said about as expected, and for 25% the period was longer than expected. Open-ended comments indicate a move to memory care was a key factor in spend down to Medicaid.