Miller Katherine E M, Coe Norma B, Kreider Amanda R, Hoffman Allison, Rhode Katherine, Gonalons-Pons Pilar
Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Health Serv Res. 2025 Apr;60 Suppl 2(Suppl 2):e14399. doi: 10.1111/1475-6773.14399. Epub 2024 Oct 18.
To examine the association of Medicaid home- and community-based services (HCBS) expenditures on the home care workforce.
DATA SOURCES/STUDY SETTING: We use two national, secondary data sources from 2008 to 2019: state-level Medicaid HCBS expenditures and the American Community Survey, in which we identify direct care workers in the home (i.e., home care workers), defined as nursing, psychiatric, and home health aides or personal care aides working in home health care services, individual and family services, and private households.
Our key explanatory variable is HCBS expenditures per state per year. To estimate the association between changes in Medicaid HCBS expenditures and the workforce size, hourly wages and hours worked, we use negative binomial, linear, and generalized ordered logit regression, respectively. All models include demographic and socioeconomic characteristics, the number of potential HCBS beneficiaries (individuals with a disability and income under the federal maximum income eligibility limits), indicators for minimum wage and/or overtime protections for direct care workers, wage pass-through policies, and state and year fixed effects.
DATA COLLECTION/EXTRACTION METHODS: We exclude states with incomplete reporting of expenditures.
States' HCBS expenditures increased between 2008 and 2019 after adjusting for inflation and the number of potential HCBS beneficiaries. Yet, home care workers' wages remained stagnant at $11-12/h. We find no association between changes in Medicaid HCBS expenditures and wages. For every additional $1 million in Medicaid HCBS expenditures, the expected number of workers increases by 1.2 and the probability of working overtime increased (0.0015% points; p < 0.05). Results are largely robust under multiple sensitivity analyses.
We find no evidence of a statistically significant relationship between changes in state-level changes in Medicaid HCBS expenditures and worker wages but do find a significant, but small, association with hours worked and workforce size.
研究医疗补助居家和社区服务（HCBS）支出与居家护理劳动力之间的关联。
数据来源/研究背景：我们使用了2008年至2019年的两个全国性二手数据源：州级医疗补助HCBS支出数据和美国社区调查数据，从中识别出居家直接护理工作者（即居家护理工作者），定义为在居家医疗服务、个人和家庭服务以及私人家庭中工作的护士、精神科助理、居家健康助理或个人护理助理。
我们的关键解释变量是各州每年的HCBS支出。为了估计医疗补助HCBS支出变化与劳动力规模、小时工资和工作时长之间的关联，我们分别使用了负二项回归、线性回归和广义有序logit回归。所有模型均纳入了人口统计学和社会经济特征、潜在HCBS受益人的数量（残疾且收入在联邦最高收入资格限制以下的个人）、直接护理工作者最低工资和/或加班保护指标、工资转嫁政策以及州和年份固定效应。
数据收集/提取方法：我们排除了支出报告不完整的州。
在对通货膨胀和潜在HCBS受益人的数量进行调整后，2008年至2019年各州的HCBS支出有所增加。然而，居家护理工作者的工资仍停滞在每小时11 - 12美元。我们发现医疗补助HCBS支出变化与工资之间没有关联。医疗补助HCBS支出每增加100万美元，预计工人数量增加1.2人，加班概率增加（0.0015个百分点；p < 0.05）。在多项敏感性分析下，结果基本稳健。
我们没有发现州级医疗补助HCBS支出变化与工人工资之间存在统计学显著关系的证据，但确实发现与工作时长和劳动力规模存在显著但较小的关联。
