Table 13: Outcome Indicators by Key Attributes of State Medicaid and Long-Term Care Environment, 2005^a

Table 13E: SMI Subpopulation

Select for:

• Table 13A: National HCBS Population.
• Table 13B: Dually Eligible HCBS Participants.
• Table 13C: Medicaid-Only HCBS Participants.
• Table 13D: I/DD Subpopulation.
• Table 13F: HCBS Population Ages 18-64 Without I/DD or SMI.
• Table 13G: HCBS Population Age 65+.

Outcome Indicator	No Medically Needy Program	More Restrictive Eligibility Criteria	Less Restrictive Eligibility Criteria	Nursing Home Level of Care Eligibility Criteria for HCBS			Percentage of State LTC Funds Spent on HCBS
				High	Mid	Low	>Median	≤Median
Short-Term Complications of Diabetes	621	615	359	916	463	430	443	605
Asthma or Chronic Obstructive Pulmonary Disease	5,994	5,285	4,259	4,724	4,897	4,975	4,530	5,703
Congestive Heart Failure	4,359	3,531	2,829	3,346	3,399	3,725	2,948	4,100
Composite: Potentially Preventable Infection	8,987	8,470	5,551	8,556	7,780	7,044	6,372	8,804
Bacterial Pneumonia	5,698	5,263	3,759	5,075	4,979	4,597	4,235	5,439
Urinary Tract Infection	3,289	3,208	1,792	3,481	2,801	2,447	2,137	3,364
Infection Due to Device or Implant	966	853	540	836	842	780	610	947
Dehydration	2,382	2,360	1,473	2,354	2,228	1,783	1,629	2,539
Composite: ACSC Chronic Conditions	14,034	12,144	10,125	11,950	11,303	11,964	10,491	13,486
Composite: ACSC Acute Conditions	8,624	8,018	5,363	7,891	7,540	6,797	6,136	8,352
Composite: ACSC Overall	22,658	20,161	15,487	19,836	18,844	18,762	16,626	21,838
Pressure Ulcer	3,490	2,892	2,126	3,314	2,623	2,679	2,298	3,287
Injurious Falls	340	266	175	175	314	210	190	322

Notes:

ACSC = ambulatory care-sensitive condition; HCBS = home and community-based services; I/DD = intellectual and development disabilities; SMI = serious mental illness; LTC = long-term care.

^a. All outcome indicators expressed as potentially avoidable hospital stays per 100,000 persons in the HCBS population. HCBS population for outcome indicators excludes: individuals under age 18; people with only institutional use in a given quarter; people on managed care plans; and persons in the States of Arizona, Maine, Washington, and Wisconsin.

Dually eligible = dually eligible for Medicaid and Medicare. Eligibility for Medicare defined as inclusion in Medicare denominator file.

Medicaid only = part of Medicaid HCBS population but not enrolled in Medicare.

HCBS subpopulations of I/DD, SMI, Under 65 Without I/DD or SMI, and 65+ are defined as in the Appendix.

Median is defined as the value at which half of States are below and half of States are above.

Source for Outcome Indicators: Agency for Healthcare Research and Quality (AHRQ), Medicaid Analytic eXtract (MAX) data, and Medicare Provider Analysis and Review (MedPAR) data.

Sources for column heading data are described in the Appendix.

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