How Medicaid Home Care Helps Caregivers Too

By Atheendar Venkataramani, MD, PhD
October 1, 2021

Atheendar Venkataramani is a physician and economist at the University of Pennsylvania, a senior fellow with the Leonard Davis Institute of Health Economics*, and a member of the 2021 Tradeoffs Research Council. His research focuses on health and socioeconomic inequality. 

Nearly 40 million Americans care for someone with a disabling health condition. The effort required to provide high quality care to a loved one can be costly, with studies showing that informal caregivers have higher rates of physical and mental illness and greater financial precarity. In a new study published in JAMA Health Forum, Emily Unger, David Grabowski, Jarvis Chen and Lisa Berkman looked at whether getting home and community-based services (HCBS) through Medicaid might take any of the burden off of these critical caregivers.

The researchers used a rigorous study design that leveraged detailed longitudinal data from the nationally-representative Medical Expenditures Panel Survey to identify low-income families with at least one member eligible for HCBS and one who wasn’t — a likely caregiver. They then compared self-reported physical and mental health outcomes for caregivers before and after the household member they were caring for received Medicaid HCBS.

Unger and colleagues found that receipt of Medicaid HCBS was associated with improved self-reported mental health within 6 months and that those improvements persisted for the length of the study, nearly 2 years. Improvements in mental health were largest among caregivers who were Hispanic, living in or near poverty, Black non-Hispanic, women, and/or caring for someone with a cognitive impairment — all groups that previous research has shown to bear greater caregiving burdens in general. The authors, however, did not find any improvements in caregivers’ self-reported physical health associated with Medicaid HCBS.

These findings are generally consistent with another recent study by Rebecca Anastos-Wallen, Rachel Werner and Paula Chatterjee, which showed caregivers in states that took advantage of increased funding for Medicaid HCBS reported getting more sleep — although the benefits in that study were more likely to accrue to caregivers with higher incomes.

Both studies have limitations. For example, neither accounts for the specific kind of HCBS people received — which can include home-based health aides, support with specific social and economic needs, and assistive technologies — and varies widely between states. But as reports indicate that lawmakers are likely to dramatically reduce President Biden’s proposal for an additional $400 billion for Medicaid HCBS, these findings suggest investing in these services could have a positive impact beyond just the people receiving them.

*The Leonard Davis Institute of Health Economics is one of Tradeoffs’ financial supporters, and their support has no influence on their inclusion in Research Corner.

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