Does Medicaid pay more to a program of all-inclusive care for the elderly (PACE) than for fee-for-service long-term care?

The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
Darryl WielandRebecca Boland

Abstract

In rebalancing from nursing homes (NHs), states are increasing access of NH-certified dually eligible (Medicare/Medicaid) patients to community waiver programs and Programs of All-Inclusive Care for the Elderly (PACE). Prior evaluations suggest Medicaid's PACE capitation exceeds its spending for comparable admissions in alternative care, although the latter may be underestimated. We test whether Medicaid payments to PACE are lower than predicted fee-for-service outlays in a long-term care admission cohort. Using grade-of-membership methods, we model health deficits for dual eligibles aged 55 or more entering waiver, PACE, and NH in South Carolina (n = 3,988). Clinical types, membership vectors, and program type prevalences are estimated. We calculate a blend, fitting PACE between fee-for-service cohorts, whose postadmission 1-year utilization was converted to attrition-adjusted outlays. PACE's capitation is compared with blend-based expenditure predictions. Four clinical types describe population health deficits/service needs. The waiver cohort is most represented in the least impaired type (1: 47.1%), NH entrants in the most disabled (4: 38.5%). Most prevalent in PACE was a dementia type, 3 (32.7%). PACE's blend was waiver: 0....Continue Reading

References

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Citations

Dec 8, 2015·Journal of the American Geriatrics Society·Erin C WestphalBruce Chernof
Jun 1, 2013·Healthcare : the Journal of Delivery Science and Innovation·Michael E Chernew, Johan S Hong
Apr 2, 2014·The Gerontologist·Justin BlackburnMeredith L Kilgore
Jul 19, 2013·International Review of Psychiatry·Deirdre Johnston
Oct 10, 2014·Journal of Aging & Social Policy·Terence NgCharlene Harrington
Jan 14, 2017·Journal of Aging & Social Policy·Lori Gonzalez
Jun 14, 2017·Population Health Management·Joe FeinglassThomas Cornwell
Feb 11, 2020·JMIR Aging·Marcia Johansson, Ponrathi Athilingam
Feb 10, 2021·Journal of Speech, Language, and Hearing Research : JSLHR·Sara K Mamo, Kara A Wheeler

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