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Medicaid Home and Community-Based Services Initiation and Acute Services Use
Emmaline Keesee, Chanee D. Fabius, Jennifer L. Kim, David G. Stevenson, Laura M. Keohane. JAMA Health Forum, 2026-03-27
Topic: Risk, prevention and care in population studies
In a sample of 1218 new HCBS users (75% female, 77% Black; mean [SD] age, 70.5 [7.5] years), Medicaid HCBS initiation was associated with a decrease in probability of ED use (-2.70 percentage points; 95% CI, -4.18 to -1.22 percentage points) and a decrease in probability of inpatient discharge (-2.63 percentage points; 95% CI, -3.75 to -1.51 percentage points). These differences represent a 24% decrease in the within-person probability of any ED use and a 32% decrease in inpatient discharge down from adjusted pre-HCBS probabilities of 11.4% and 8.1%. Event-month trends demonstrated discontinuity at HCBS initiation and reduced the probability of acute services use that was maintained 6 months thereafter. The number of unique drugs filled steadily increased before and after HCBS, with no discontinuity observed at HCBS initiation. Conclusions and Relevance: In this study among a large cohort of older adults with low income across the southeastern US, Medicaid HCBS was associated with a persistent decrease in acute services use. Future research should explore additional outcomes to better inform policies that can improve HCBS outcomes and an understanding of its tradeoffs with acute services use.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Keesee, E., Fabius, C. D., Kim, J. L., Stevenson, D. G., & Keohane, L. M. (2026). Medicaid Home and Community-Based Services Initiation and Acute Services Use. JAMA Health Forum. https://doi.org/10.1001/jamahealthforum.2026.0206
Vancouver
Keesee E, Fabius CD, Kim JL, Stevenson DG, Keohane LM. Medicaid Home and Community-Based Services Initiation and Acute Services Use. JAMA Health Forum. 2026. doi:10.1001/jamahealthforum.2026.0206. PMID: 41893618.
BibTeX
@article{keesee2026-41893618,
author = {Keesee, Emmaline and Fabius, Chanee D. and Kim, Jennifer L. and Stevenson, David G. and Keohane, Laura M.},
title = {{Medicaid Home and Community-Based Services Initiation and Acute Services Use}},
journal = {JAMA Health Forum},
year = {2026},
doi = {10.1001/jamahealthforum.2026.0206},
pmid = {41893618},
url = {https://doi.org/10.1001/jamahealthforum.2026.0206}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
Key findings
- In a sample of 1218 new HCBS users (75% female, 77% Black; mean [SD] age, 70.5 [7.5] years), Medicaid HCBS initiation was associated with a decrease in probability of ED use (-2.70 percentage points; 95% CI, -4.18 to -1.22 percentage points) and a decrease in probability of inpatient discharge (-2.63 percentage points; 95% CI, -3.75 to -1.51 percentage points).
- These differences represent a 24% decrease in the within-person probability of any ED use and a 32% decrease in inpatient discharge down from adjusted pre-HCBS probabilities of 11.4% and 8.1%.
- Event-month trends demonstrated discontinuity at HCBS initiation and reduced the probability of acute services use that was maintained 6 months thereafter.
- The number of unique drugs filled steadily increased before and after HCBS, with no discontinuity observed at HCBS initiation.
- Conclusions and Relevance: In this study among a large cohort of older adults with low income across the southeastern US, Medicaid HCBS was associated with a persistent decrease in acute services use.
Why it matters
This cohort study found that Medicaid Home and Community-Based Services initiation was associated with a persistent decrease in emergency department use and inpatient discharges among older adults with low income. It does not address treating, curing, or preventing Alzheimer's disease.
Study details
- Study designcohort study
- Effect size11.4%; 8.1%
- Evidence strengthModerate
How this study scored 46/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for sample size, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (JAMA Health Forum) |
| Journal's citation record | 0 / 4 | JAMA Health Forum: journal h-index 60 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 1 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.5 citations a year over 2 year(s) since 2026 |
| Impact for its field and year | 3 / 6 | Cited 7.4× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 1 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Laura M. Keohane: h-index 15 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Johns Hopkins University: institution h-index 2,306 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 41893618) |
| Free to read | 2 / 2 | Free to read |
| Total | 46 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1001/jamahealthforum.2026.0206
- PubMed: 41893618
- Original source →
- Free full text: JAMA Health Forum →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
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