Medicaid may be an important mechanism for linking older rural residents with formal home care, especially Medicare home health care, according to a study by researchers at the Agency for Healthcare Research and Quality. They used combined data from the 1998 Medical Expenditure Panel Survey-Household Component with data from the Area Resource File to examine the impact of rural-urban residence on use of formal home care (reimbursed by Medicare or any source) among older people and to determine whether and how Medicaid coverage influenced this association.
After adjusting for other factors affecting use of home care, results pointed to an interplay between residential status and Medicaid coverage with regard to formal home care use. Compared with metropolitan residents covered by Medicaid, the likelihood of any formal home care use was significantly higher for Medicaid enrollees residing in non-metropolitan counties having no town of 10,000 or more people. Use of Medicare home health care was significantly greater for residents of the most rural counties, irrespective of their Medicaid coverage.
Within these very rural counties, Medicare home care may substitute for other forms of health and long-term care that would normally be reimbursed thorough Medicare but that are less available, such as hospitals or advanced medical services. The results suggest that for older people in rural counties, Medicaid coverage may facilitate access to acute and chronic care services (perhaps through primary care case management programs that link elders to formal home care or other services), especially Medicare home health services.
Details are in "The influence of rural location on utilization of formal home care: The role of Medicaid," by William J. McAuley, Ph.D., William D. Spector, Ph.D., Joan Van Nostrand, D.P.A., and Tom Shaffer, M.H.S., in Gerontologist 44(5), pp. 655-664, 2004.
Reprints (AHRQ Publication No. 05-R010) are available from the AHRQ Publications Clearinghouse.