Racial disparities in Medicaid home and community-based service utilization and expenditures among persons with multiple sclerosis

BMC Health Serv Res. 2018 Oct 12;18(1):773. doi: 10.1186/s12913-018-3584-x.


Background: Medicaid home and community-based services (HCBS) provide services such as personal care, nursing, and home-delivered meals to aging adults and individuals with disabilities. HCBS are available to people across racial and ethnic groups, yet racial disparities in Medicaid HCBS utilization and expenditures have been understudied. Individuals with multiple sclerosis (MS) may be particularly impacted by HCBS, as nearly one-third requires assistance at home. The present study examined whether disparities exist in Medicaid HCBS utilization and expenditures among HCBS users with MS.

Methods: We used secondary data to conduct a retrospective cohort analyses including 7550 HCBS recipients with MS. Demographic data was obtained from the Medicaid Analytic eXtract Personal Summary file, Medicaid HCBS service utilization and expenditures were obtained from the Other Therapy file, and comorbidities from the Medicare Chronic Condition Warehouse. Univariate and bivariate statistics were used to describe the sample and provide comparisons of characteristic by race. Logistic regression predicted the likelihood of using HCBS type and gamma regression was used to predict Medicaid HCBS expenditures.

Results: Black HCBS users were younger, more likely to be female, and were more impaired than Whites. Multivariate analyses showed that Blacks were less likely to receive case management, equipment, technology and modification services, and nursing services compared to Whites. Additionally, Black men had the lowest Medicaid HCBS expenditures, while White men had the highest.

Conclusions: Findings shed light on disparities among HCBS users with MS. As Blacks are already disproportionately affected by MS, these results reveal target areas for future research. Future work should examine the factors that contribute to these disparities, as well as determine the extent to which these inequities impact outcomes such as hospitalizations and nursing home admissions.

Keywords: Disparities; Home and community-based services; Race.

MeSH terms

  • Adult
  • African Americans*
  • Disabled Persons
  • European Continental Ancestry Group*
  • Female
  • Health Expenditures / statistics & numerical data*
  • Home Care Services / statistics & numerical data*
  • Humans
  • Logistic Models
  • Male
  • Medicaid / statistics & numerical data*
  • Middle Aged
  • Multiple Sclerosis / economics
  • Multiple Sclerosis / ethnology*
  • Multiple Sclerosis / therapy
  • Patient Acceptance of Health Care / statistics & numerical data
  • Retrospective Studies
  • United States