To better understand the population of Medicaid enrollees qualifying for benefits on the basis of age or disability and living in nursing homes or ICFs/IID, we analyzed data from the Medicaid Analytic eXtract (MAX) from 2006 and 2007 to address the following two sets of research questions:
What are the characteristics of enrollees remaining in nursing homes and ICFs/IID and their stays?
- How many enrollees had new spells of nursing home care or ICF/IID care?
- How did the number of enrollees with new spells of nursing home care change over time?
- What were the demographic characteristics of enrollees who used nursing home or ICF/IID care?
- How did enrollees residing in nursing homes or ICFs/IID become eligible for Medicaid?
- How long did enrollees live in nursing homes or ICFs/IID?
- Did enrollees receiving nursing home or ICF/IID care also use HCBS before or after their institutional stay?
- Did enrollees use both nursing home and ICF/IID care?
How does the length of institutional spells vary at the state level with changes in state constraints and policies? State-level variables examined included the following:
- The percentage of Medicaid LTC spending allocated to HCBS.
- The percentage of Medicaid LTC users' total Medicaid expenditures accounted for by HCBS recipients.
- The percentage of Medicaid LTC recipients using HCBS.
- The percentage of potential Medicaid LTC recipients using HCBS.
- The supply of nursing home beds per 1,000 elderly.
- The percentage of ICFs/IID that are large (more than 15 beds).
- The percentage change in the number of ICFs/IID from 2006 to 2007.
- The percentage change in the number of large ICFs/IID from 2006 to 2007.
Given the differences in the characteristics and needs of the two populations, we performed the analyses separately for nursing home and ICF/IID utilization, although as part of our analysis of enrollees living in ICFs/IID, we also examined enrollees who had stays at both types of facility. Because Wenzlow et al. (2008) performed a similar analysis for enrollees receiving nursing home care using earlier data, we also compared some of the findings reported here to those from the earlier report.