Abstract
Objectives
This study examines the effect of Medicaid eligibility expansion under the Affordable
Care Act (ACA) on the utilization of nursing home services by younger individuals
and those covered by Medicaid.
Design
Compared the age of nursing home residents, proportion of individuals covered by Medicaid,
annual nursing home admissions in those younger than 65, and nursing home length of
stay in states that expanded Medicaid eligibility through the ACA to states that did
not. We used data from LTCFocus (nursing home level), the Minimum Data Set (individual
level), and Medicaid expansion status from the Kaiser Family Foundation.
Setting and Participants
The study included 15,005,888 nursing home admissions, 2,446,950 of which were residents
younger than 65, across 14,132 nursing homes between 2009 and 2016.
Methods
A time-varying difference-in-difference model including state and year fixed effects
with effect modification by pre-2014 nursing home occupancy.
Results
Facilities in expansion states with a pre-ACA occupancy rate of more than 70% increased
the fraction of residents younger than 65 by 2.74% to 6.32%, compared with similar
facilities in nonexpansion states. Medicaid admissions varied, with an increase in
year 2 after expansion compared with nonexpansion states. Among residents entering
from an acute care hospital, the proportion younger than 65 increased in facilities
with pre-2014 occupancy rates of more than 70%, compared with similar facilities in
nonexpansion states, an increase of up to 6.51%. Median nursing home length of stay
for individuals younger than 65 decreased relative to nonexpansion states across all
occupancy categories, ranging from 1.68 to 6.06 days after Medicaid expansion.
Conclusions and Implications
Medicaid expansion increased access to nursing home post-acute care for individuals
younger than 65. It remains unclear if the benefit of post-acute care is the same
among this group, or if the needs of younger individuals can be adequately met in
this setting.
Keywords
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Article info
Publication history
Published online: September 20, 2021
Footnotes
This work was supported by the Agency for Healthcare Research and Quality (T32 HS026116–01), the National Institute on Aging (P30AG059302), and the Resource Centers for Minority Aging Research (5P30AG059302).
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
ScienceDirect
Access this article on ScienceDirectRelated Podcast
May 17, 2022
May 2022 Issue: Screening for Sepsis, Families as Caregivers in the Nursing Home, and The Growing Population of Nursing Home Residents Younger than 65
Host: Dr. Karl Steinberg. Featuring Dr. Philip Sloane, Dr. Mallory Brown.
https://mcdn.podbean.com/mf/download/hve3vh/JOTG-2022-05-25_mixdown_incresed_gain.mp3
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