Performance Improvement 2009. How Many Medicaid Nursing Home Users Enroll in Medicaid Before Their Nursing Home Stays Begin; How Does This Pattern Vary Across States?


This study examined nursing home stays, and how they vary across population groups and states. Although Medicaid expenditures for nursing home care are well-documented, little is known about the characteristics of people who use nursing home services. All Medicaid enrollees who reside in nursing homes must meet Medicaid income and asset requirements but pathways to Medicaid eligibility can vary greatly.

The study found that almost 46% of all nursing home users had new spells of nursing home care paid in part by Medicaid during the 18-month period of observation. There is considerable transition in and out of Medicaid nursing home care--due to death, extended hospital stays, Medicare-covered acute care stays, limited need, or availability of community-based services. The primary eligibility pathways for Medicaid-covered nursing home care nationwide were through the long-term care associated eligibility criteria, which include people qualifying under the 300% rule. Almost 48% qualified under this long-term care associated eligibility group, 23% qualified as a result of Supplemental Security Income receipt, 22% qualified under medically needy provisions, and 6% qualified under their state’s poverty criteria. About 64% of enrollees with new nursing home spells were already enrolled in Medicaid at the start of their spell whereas 36% were new enrollees. Almost half of new enrollees were already in a nursing home prior to their spell start, most likely because they entered as Medicare skilled nursing facility residents or spent down their savings while institutionalized to become Medicaid eligible. Over half of enrollees beginning Medicaid-financed nursing home spells were already residing in nursing homes when Medicaid began financing part of their stay. The duration of spells was bimodal, indicating that two distinct types of people utilized Medicaid-covered nursing home care: those needing care for acute conditions and those requiring longer term care. Duration of nursing home spells was negatively associated with availability of community-based services in a state. States with significant community-based programs tended to have a higher percentage of people using community-based services before entering nursing homes.

Report Title: Medicaid-Financed Nursing Home Services: Characteristics of People Served and Their Patterns of Care, 2001-2002
Agency Sponsor: ASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy
Federal Contact: John Drabek, 202-690-6443
Performer: Mathematica Policy Research, Inc.
PIC ID: 8901

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