Predictors of Nursing Facility Entry by Medicaid-Only Older Adults and Persons With Disabilities in California

Michelle J Ko, Robert J. Newcomer, Charlene Harrington, Denis Hulett, Taewoon Kang, Andrew B. Bindman

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Nearly one-third of adult Medicaid beneficiaries who receive long-term services and supports (LTSS) consist of older adults and persons with disabilities who are not eligible for Medicare. Beneficiaries, advocates, and policymakers have all sought to shift LTSS to home and community settings as an alternative to institutional care. We conducted a retrospective cohort study of Medicaid-only adults in California with new use of LTSS in 2006-2007 (N = 31 849) to identify unique predictors of entering nursing facilities versus receiving Medicaid home and community-based services (HCBS). Among new users, 18.3% entered into nursing facilities, whereas 81.7% initiated HCBS. In addition to chronic conditions, functional and cognitive limitations, substance abuse disorders (odds ratio [OR] 1.35; 95% confidence interval [CI]: 1.23, 1.48), and homelessness (OR: 4.35, 9% CI: 3.72, 5.08) were associated with higher odds of nursing facility entry. For older adults and persons with disabilities covered by Medicaid only, integration with housing and behavioral health services may be key to enabling beneficiaries to receive LTSS in noninstitutional settings.

Original languageEnglish (US)
JournalInquiry : a journal of medical care organization, provision and financing
StatePublished - Jan 1 2018


  • home and community-based services
  • long-term services and supports
  • Medicaid
  • skilled nursing facilities

ASJC Scopus subject areas

  • Health Policy


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