Medicaid Savings Resulted When Community Health Workers Matched Those With Needs to Home and Community Care

Felix HC, Mays GP, Stewart MK, Cottoms N, Olson M
Source: Health Affairs
Publication Year: 2011
Patient Need Addressed: Long-term services and supports
Population Focus: Medicaid beneficiaries, Vulnerable/disadvantaged
Demographic Group: Adult, Rural
Intervention Type: Staff design and care management
Type of Literature: White

The Affordable Care Act of 2010 builds on earlier efforts to expand home and community-based alternatives to institutional long-term care. Identifying people living in the community who have unmet long-term care needs and who may be at risk for entering nursing homes may be crucial to these efforts. The Arkansas Community Connector Program used specially trained community health workers to identify such people in three disadvantaged counties and connect them to Medicaid home and community-based services. The result was a 23.8 % average reduction in annual Medicaid spending per participant during the period 2005-08. Net three-year savings to the Arkansas Medicaid program equaled $2.619 million. Similar interventions may help other localities achieve cost-saving and equitable access to publicly funded long-term care options other than institutional care.

Insights Results

Overview of article/program

  • This study suggests that community health workers can help states cost-effectively direct home and community-based long-term care services to disabled and elderly residents who face elevated risks of entering nursing homes, particularly among underserved populations such as Blacks and residents of rural areas
  • Arkansas’ Community Connector Program is a Medicaid demonstration program that uses community health workers for targeted outreach to adults in the community who have unmet long-term care needs. Once the Medicaid-eligible adults with unmet long-term care needs are identified, community health workers connect them to agencies offering needed services. The community health workers attempted to increase consumers’ knowledge and access by providing information about available home and community-based services and eligibility requirements for those services. To do this, they canvassed the community, going door to door, and passed out program literature at events. They received formal referrals from physicians, staff at county public health units, and hospital discharge planners and informal referrals from family, friends, and church leaders
  • The Community Connector Program employs approximately 6 full-time community health workers to provide home and community-based long-term care outreach

    Methods of article

    • Using a longitudinal, quasi-experimental research design, an intervention group of 919 Medicaid recipients served by the Community Connector Program for 3 years, in 3 intervention counties, was observed before and after program enrollment and compared with a statistically matched, contemporaneous group of 944 Medicaid recipients located in 5 nearby counties
    • Annual measures for use of Medicaid services and spending for inpatient and outpatient medical services, nursing home services, home and community-based services, and other services were constructed and used as outcomes


    • Annual Medicaid spending for program participants averaged $16,074 per person during the year before program participation. It increased to $19,174 per person during the last year of participation, resulting in an unadjusted increase of 19.3 % over the 3-year study period
    • Among program participants in the intervention group, the largest increase in spending was for home and community-based services, which increased significantly—from $7,762 per person to $10,618 per person during the study period
    • Overall, spending on home health services and home and community-based services increased significantly in the intervention group relative to the comparison group, while spending on nursing home services increased significantly in the comparison group relative to the intervention group
    • Overall, the program produced over $3million in Medicaid savings during the 3 year demonstration. Offset by ~$900,000 in operational expenses, net savings for the program were $2.6 million

    Key takeaways/implications

    • These findings help to dispel concerns that proving home and community-based health services necessarily increase Medicaid spending. Instead, they indicate that it can pay to actively seek out and provide people and their unmet long-term care needs
    • Standard outreach and targeting methods that require formal referrals or contacts initiated by people with unmet needs, including Internet-based inquiries, may be inadequate for various reasons (e.g., limited access to electronic information, lack of physician willingness to refer)
    • Key rationale for the success of the program may include its nontraditional mode of identifying and providing unmet needs (i.e., community health worker engagement), ability to reach blacks and residents of rural areas
    • Limitations to the study include the use of estimation in the propensity score method, vulnerability to bias, inability to generalize results to all Community Connector Program participants