Users of Medicaid home and community-based services are especially vulnerable to costly avoidable hospital admissions.

Although Medicaid's coverage of home and community-based services and the program's capacity to provide such services have increased markedly in recent years, relatively little is known about the population that uses these services. We combined Medicaid and Medicare data to characterize the national Medicaid population of service users by key demographic and health-related attributes. We also assessed one important dimension of their health outcomes: potentially avoidable hospital admissions. We found that in 2005 there were 2.2 million users of Medicaid home and community-based services-almost 4 percent of the total Medicaid population-and that two-thirds of these users were dually eligible for Medicare and Medicaid. Users of home and community-based services were particularly vulnerable to avoidable hospital admissions, compared to the full Medicaid and US populations, and these hospitalizations occur at substantial cost to public payers. For the dual eligibles using home and community-based services, Medicare pays most of the costs of these avoidable hospital stays. Our findings emphasize the need for further research to establish policies and practices that can best meet the needs of users of Medicaid home and community-based services.