Beyond Spend-down: The Prevalence and Process of Transitions to Medicaid. Implications for policy


  • Current efforts and trends toward changing the locus of LTSS from nursing homes to community settings may be able to reduce the rate of transitions
  • Increased provision of Medicaid HCBS modestly increases the rate of transitions but may have long-term beneficial effects on costs
  • Policies to improve access to affordable prefunding earlier in life might be able to bridge gaps between financial means and care needs for those with modest retirement income and resources
  • Increased supports for informal caregivers may be able to reduce nursing home admissions and Medicaid transitions

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