Transition Rates from the Community to Nursing Home Care Among Older Adult Medicaid Enrollees, 2006-2009

This study is a follow-up to earlier research conducted with 2006 and 2009 Medicaid (Medicaid Analytic eXtract [MAX]) data on interstate variations on the extent of the “rebalancing” of Medicaid long-term services and supports (LTSS) from nursing home care toward greater reliance on home and community-based services (HCBS). The present study focuses on interstate variations in transition rates of older adult Medicaid enrollees from the community in 2006 to nursing home care over the three-year period from 2007 through 2009. We found that more highly “rebalanced” states (those with proportionately higher spending on HCBS and higher numbers of LTSS users receiving HCBS relative to institutional care) had lower rates of transition to nursing home care among all older adult Medicaid enrollees living in the community, including those who received HCBS while in the community as well as those who did not. Just as our earlier research found certain Medicaid program and other state characteristics that can be influenced by policymaking to be associated with LTSS systems that were more oriented toward HCBS, this study also identified statistically significant correlations between a number of Medicaid and other state characteristics and lower rates of transition of older adult Medicaid enrollees from the community to nursing home care. The state characteristics associated with lower rates of nursing home transition include: greater proportionate levels of LTSS expenditures going to HCBS, higher percentages of LTSS users receiving HCBS, greater likelihood of HCBS rather than nursing facilities being the first LTSS used, higher HCBS spending per HCBS user, lower numbers of nursing facility beds per 1,000 state residents age 65 and older, and lower percentages of nursing facility residents assessed with low care needs. These findings suggest that some features of Medicaid program design and state LTSS infrastructure over which state policymakers can exert considerable influence are associated with lower transitions to nursing home care.