Abstract
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 language | English (US) |
|---|---|
| Journal | Inquiry : a journal of medical care organization, provision and financing |
| Volume | 55 |
| DOIs | |
| State | Published - Jan 1 2018 |
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Keywords
- home and community-based services
- long-term services and supports
- Medicaid
- skilled nursing facilities
ASJC Scopus subject areas
- Health Policy
Cite this
Predictors of Nursing Facility Entry by Medicaid-Only Older Adults and Persons With Disabilities in California. / Ko, Michelle J; Newcomer, Robert J.; Harrington, Charlene; Hulett, Denis; Kang, Taewoon; Bindman, Andrew B.
In: Inquiry : a journal of medical care organization, provision and financing, Vol. 55, 01.01.2018.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Predictors of Nursing Facility Entry by Medicaid-Only Older Adults and Persons With Disabilities in California
AU - Ko, Michelle J
AU - Newcomer, Robert J.
AU - Harrington, Charlene
AU - Hulett, Denis
AU - Kang, Taewoon
AU - Bindman, Andrew B.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - 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.
AB - 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.
KW - home and community-based services
KW - long-term services and supports
KW - Medicaid
KW - skilled nursing facilities
UR - http://www.scopus.com/inward/record.url?scp=85056410799&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85056410799&partnerID=8YFLogxK
U2 - 10.1177/0046958018768316
DO - 10.1177/0046958018768316
M3 - Article
VL - 55
JO - Inquiry
JF - Inquiry
SN - 0046-9580
ER -