Beyond Spend-down: The Prevalence and Process of Transitions to Medicaid. Summary of major findings


  • 5% of community residents transition to Medicaid over 4 years
    • 56% percent of transitions occur in the community
    • 10% occur at nursing home admission, and 34% occur an average 9 months after admission
  • Nursing home use is by far the greatest predictor of transition followed by low income & assets
    • Nearly 30% of the poor and near poor who used nursing homes transitioned vs about 6% of nonusers
    • Homeowners were less likely to transition, but even higher income homeowners were 8 times more likely to transition if they used nursing homes (4% vs 0.5% for nonusers).
  • Baseline cognitive impairment associated with 3 percentage point increase in cumulative risk of transition
  • More generous state eligibility standards and HCBS commitment associated with higher risk of transition

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