{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T08:38:23Z","timestamp":1792485503938,"version":"4.5.0"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100014848","name":"Arnold Ventures","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100014848","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess existing algorithms for measuring Home\u2010 and Community\u2010Based Services (HCBS) in Medicaid claims, and to develop and evaluate a unified, modified algorithm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>Using Transformed Medicaid Statistical Information System Analytic Files (TAF), we compared two existing algorithms for identifying and classifying 1915(c) waiver and state plan HCBS. Informed by that analysis, we developed a third, unified and modified algorithm. Using each algorithm, we constructed annual state\u2010level estimates of HCBS use per 100,000 residents, which we compared from 2021 to 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>National 20% sample of TAF data. The sample included continuously enrolled, full\u2010benefit Medicaid beneficiaries age 19 or older in 2021 for primary analyses, and 2022\u20132023 to compare counts over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>\n                      The existing algorithms showed a high level of concordance (observed agreement,\n                      <jats:italic>P<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>o<\/jats:italic>\n                      <\/jats:sub>\n                      \u2009=\u200993% and kappa\u2009=\u20090.77). Disagreement resulted from missing or inconclusive program type codes, differences in service\u2010related codes used to classify HCBS, and differences in classifying claims for capitated payments. Our algorithm addressed some of this disagreement with the novel use of waiver identification numbers and modification of some TAF data elements and codes. HCBS user counts were mostly consistent across algorithms, with our algorithm identifying the broadest population of users. However, some states exhibited inconsistent counts depending on the algorithm, implausibly high counts (Pennsylvania and Illinois), or implausibly low counts (Mississippi). In several states, HCBS user counts varied substantially from 2021 to 2023 (&gt;\u200950% in absolute value), suggesting changes in data quality or reporting in those states across years.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our algorithm resolves some discordances between two existing algorithms for measuring HCBS use in TAF. However, in certain states and years, inconsistent or implausible HCBS user counts suggest variations in data reliability and coding patterns that could limit accurate measurement of HCBS, regardless of the algorithm used.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70164","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T05:52:09Z","timestamp":1789624329000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["How Should We Identify Home\u2010 and Community\u2010Based Services (\n                    <scp>HCBS<\/scp>\n                    ) in Medicaid Claims Data? An Evaluation and Synthesis of Algorithms"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2303-2098","authenticated-orcid":false,"given":"Vimbainashe","family":"Dihwa","sequence":"first","affiliation":[{"name":"Perelman School of Medicine and Leonard Davis Institute of Health Economics University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7439-0799","authenticated-orcid":false,"given":"Eric T.","family":"Roberts","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine and Leonard Davis Institute of Health Economics University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliza","family":"Macneal","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine and Leonard Davis Institute of Health Economics University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7760-203X","authenticated-orcid":false,"given":"Kenton J.","family":"Johnston","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7687-1265","authenticated-orcid":false,"given":"Ari","family":"Ne\u2032eman","sequence":"additional","affiliation":[{"name":"Harvard T.H. Chan School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"Trends in Users and Expenditures for Home and Community\u2010Based Services as a Share of Total Medicaid LTSS Users and Expenditures, 2022","author":"Murray C.","year":"2024"},{"key":"e_1_2_10_3_1","unstructured":"Centers for Medicare and Medicaid Services \u201cHome & Community Based Services. Medicaid.gov. \u201d accessed September 15 2025 https:\/\/www.medicaid.gov\/medicaid\/home\u2010community\u2010based\u2010services."},{"key":"e_1_2_10_4_1","volume-title":"Medicaid Long\u2010Term Services and Supports Use and Expenditures by Service Category, 2019\u20132021","author":"Stepanczuk C.","year":"2024"},{"key":"e_1_2_10_5_1","unstructured":"J.Rooney C.Irvin J.Self et\u00a0al. \u201cIdentifying and Classifying Medicaid Home and Community\u2010Based Services Claims in the Transformed Medicaid Statistical Information System 2016\u20132020 \u201d(2023) https:\/\/aspe.hhs.gov\/reports\/identifying\u2010classifying\u2010medicaid\u2010hcbs\u2010t\u2010msis."},{"key":"e_1_2_10_6_1","unstructured":"M.MusumeciandE.Leiser \u201cCMS Is Taking Steps to Identify Unmet Need for Medicaid Home and Community\u2010Based Services for Older Adults and People with Disabilities \u201d(2024) https:\/\/doi.org\/10.26099\/G2N2\u2010NW32."},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.14643"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.14325"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2024.2187"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/08959420.2023.2183678"},{"key":"e_1_2_10_11_1","unstructured":"E.Greener A.Carpenter andL.Nolan \u201cIdentifying Home and Community\u2010Based Services and the Enrollees Who Use Them in the TAF \u201d(2023) https:\/\/www.medicaid.gov\/dq\u2010atlas\/downloads\/supplemental\/7061\u2010Identifying\u2010HCBS\u2010in\u2010TAF.pdf."},{"key":"e_1_2_10_12_1","volume-title":"Methodology for Identifying Medicaid Long\u2010Term Services and Supports Expenditures and Users, 2022","author":"Stepanczuk C.","year":"2024"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10742\u2010024\u201000325\u20106"},{"key":"e_1_2_10_14_1","volume-title":"Measuring Medicaid Service Utilization Among Dual Medicare\u2010Medicaid Enrollees Using Fee\u2010For\u2010Service and Encounter Claims: T\u2010MSIS Analytic Files Data Quality","author":"Caswell K. J.","year":"2021"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2025.3622"},{"key":"e_1_2_10_16_1","unstructured":"U.S. Census Bureau \u201cResident Population for the 50 States the District of Columbia and Puerto Rico: 2020 Census \u201d(2021) https:\/\/www.census.gov\/data\/tables\/2020\/dec\/2020\u2010apportionment\u2010data.html."},{"key":"e_1_2_10_17_1","unstructured":"Centers for Medicare & Medicaid Services \u201cHome\u2010 and Community\u2010Based Services. CMS.gov. \u201dhttps:\/\/www.cms.gov\/training\u2010education\/partner\u2010outreach\u2010resources\/american\u2010indian\u2010alaska\u2010native\/ltss\u2010ta\u2010center\/information\/ltss\u2010models\/home\u2010and\u2010community\u2010based\u2010services."},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.6084\/m9.figshare.32984042"},{"key":"e_1_2_10_19_1","unstructured":"Centers for Medicare and Medicaid Services \u201cState Waivers List\u201d Medicaid.gov accessed October 13 2025 https:\/\/www.medicaid.gov\/medicaid\/section\u20101115\u2010demo\/demonstration\u2010and\u2010waiver\u2010list."},{"key":"e_1_2_10_20_1","unstructured":"Centers for Medicare and Medicaid Services \u201cReporting Waiver\u2010Type and Waiver\u2010Identifier in T\u2010MSIS (Special Programs) \u201d T\u2010MSIS Data Guide accessed October 2025 https:\/\/www.medicaid.gov\/tmsis\/dataguide\/t\u2010msis\u2010coding\u2010blog\/reporting\u2010waiver\u2010type\u2010and\u2010waiver\u2010identifier\u2010in\u2010t\u2010msis\u2010special\u2010programs\/."},{"key":"e_1_2_10_21_1","unstructured":"Centers for Medicare & Medicaid Services \u201cDQ Assessments: 1915(c) Waiver Participation by State \u201dMedicaid and CHIP Data Quality Atlas https:\/\/www.medicaid.gov\/dq\u2010atlas\/landing\/topics\/single\/map?topic=g1m82&tafVersionId=35."},{"key":"e_1_2_10_22_1","unstructured":"MACPAC \u201cMACStats Archive MACPAC (Medicaid and CHIP Payment and Access Commission) \u201d(2023) https:\/\/www.macpac.gov\/publication\/macstats\u2010archive\/."},{"key":"e_1_2_10_23_1","unstructured":"Centers for Medicare and Medicaid Services \u201cDQ Atlas Assessment: Eligibility Group Code \u201dMedicaid and CHIP Data Quality Atlas https:\/\/www.medicaid.gov\/dq\u2010atlas\/landing\/topics\/single\/table?topic=g3m20&tafVersionId=25."},{"key":"e_1_2_10_24_1","unstructured":"KFF \u201cMedicaid Enrollees Using Home Care Services (HCBS) 2021 \u201d State Health Facts https:\/\/www.kff.org\/medicaid\/state\u2010indicator\/medicaid\u2010enrollees\u2010using\u2010home\u2010care\u2010services\/."},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u20102288\u20109\u20105"}],"container-title":["Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70164","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1475-6773.70164","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.70164","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:40:14Z","timestamp":1792482014000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1475-6773.70164"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":25,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/1475-6773.70164"],"URL":"https:\/\/doi.org\/10.1111\/1475-6773.70164","archive":["Portico"],"relation":{},"ISSN":["0017-9124","1475-6773"],"issn-type":[{"value":"0017-9124","type":"print"},{"value":"1475-6773","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"assertion":[{"value":"2026-03-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-06","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70164"}}