ArticleHealth services research2024
State home and community-based services expenditures and unmet care needs in the United States: Has everyone benefitted equally?
Article in Health services research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
10 citing papers in PubMed.
- Medicaid funds direct care for one in four dual-eligible older adults nationally, but state variation is 4-fold.Health affairs scholar · 2026Article
- Misperception, self-reported probabilities and long-term care insurance take-up in the United States.International journal of health economics and management · 2026Article
- Examining State Policies and Administrative Factors as Determinants of Consumer-Reported Unmet Service Needs in Publicly Funded Home- and Community-Based Services in the United States.Journal of market access & health policy · 2025Article
- Geographic Proximity of Family Members and the Provision of Unpaid and Paid Care for Older Adults Not Living With a Spouse: A Cross-Sectional Study.Health science reports · 2025Article
- Has Increased Medicaid Spending on Home- and Community-Based Services Reduced Unmet Needs in Activities of Daily Living Care among Community-Dwelling Older Adults with Dementia? Evidence from 2008 to 2020.Journal of the American Medical Directors Association · 2025Article
- Increasing expenditures on home- and community-based services: Do home care workers benefit?Health services research · 2025Article
- Making Oneself "Fit": Community Perspectives on Disaggregated Race and Ethnicity Data Collection and Reporting in Healthcare Settings.Journal of racial and ethnic health disparities · 2025Article
- State home- and community-based services spending and unmet care needs by living arrangements and cognitive impairment status.Journal of the American Geriatrics Society · 2024Article
- State home and community-based services expenditures and unmet care needs in the United States: Has everyone benefitted equally?Health services research · 2024Article
- The critical role of Medicaid home- and community-based services in meeting the needs of older adults in the United States.Health services research · 2024Article
Corrections and comments
- Commented on by
Authors and funding
6 authors.
Funding
Abstract
objectiveTo test whether the impacts of Medicaid's Home and Community-Based Services (HCBS) expenditures have been equitable. DATA SOURCES AND STUDY
settingThis is a secondary data analysis. We linked annual data on state-level Medicaid HCBS expenditures with individual data from U.S. Health and Retirement Study (HRS; 2006-2016). STUDY
designWe evaluated the association between state-level HCBS expenditure quartiles and the risk of experiencing challenges in basic or instrumental activities of daily living (I/ADLs) without assistance (unmet needs for care). We fitted generalized estimating equations (GEE) with a Poisson distribution, log link function, and an unstructured covariance matrix. We controlled demographics, time, and place-based fixed effects and estimated models stratified by race and ethnicity, gender, and urbanicity. We tested the robustness of results with negative controls. DATA COLLECTION/EXTRACTION
methodsOur analytic sample included HRS Medicaid beneficiaries, aged 55+, who had difficulty with ≥1 I/ADL (n = 2607 unique respondents contributing 4719 person-wave observations). PRINCIPAL
findingsAmong adults with IADL difficulty, higher quartiles of HCBS expenditure (vs. the lowest quartile) were associated with a lower overall prevalence of unmet needs for care (e.g., Prevalence Ratio [PR], Q4 vs. Q1: 0.91, 95% CI: 0.84-0.98). This protective association was concentrated among non-Hispanic white respondents (Q4 vs. Q1: 0.82, 95% CI: 0.73-0.93); estimates were imprecise for Hispanic individuals and largely null for non-Hispanic Black participants. We found no evidence of heterogeneity by gender or urbanicity. Negative control robustness checks indicated that higher quartiles of HCBS expenditure were not associated with (1) the risk of reporting I/ADL difficulty among 55+ Medicaid beneficiaries, and (2) the risk of unmet care needs among non-Medicaid beneficiaries.
conclusionThe returns to higher state-level HCBS expenditures under Medicaid for older adults with I/ADL disability do not appear to have been equitable by race and ethnicity.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.