Financing Long-Term Services and Supports: Continuity and Change

Wiener, Joshua M.; Knowles, Martyn; White, Erin

doi:10.3768/rtipress.2017.op.0042.1709

Cited by 6 publications

(7 citation statements)

References 10 publications

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“…In contrast, we examine changes that respondents experience in the 2-year period during which Medicaid entry occurs. To the best of our knowledge, only one other study has used linked survey and administrative data to examine Medicaid entry (Wiener et al, 2013); unlike our study, it focuses on respondent traits measured before entry (rather than changes in respondent circumstances), and it uses data prior to the expansion of partial Medicaid under the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008.…”

Section: New Contributionsmentioning

confidence: 99%

“…Prior studies have found that Medicaid entry is positively associated with Black race, Hispanic ethnicity, low levels of education, worse health status, and being unmarried (Tavares et al, 2020;Wiener et al, 2013) as well as prior high OOP medical spending, the lack of supplementary health insurance (Willink et al, 2016), trouble paying for medical bills (Willink et al, 2019), prior health care use (Borck et al, 2014;Keohane et al, 2017Keohane et al, , 2018Lim et al, 2014;Stockwell et al, 2012), and some state and federal policies (Keohane et al, 2016(Keohane et al, , 2019. Although these studies provide valuable information on Medicaid entry, many use Medicare claims data only and, as a result, are not able to measure income and assets.…”

Section: Introductionmentioning

confidence: 99%

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Examining Medicaid Participation and Medicaid Entry Among Senior Medicare Beneficiaries With Linked Administrative and Survey Data

et al. 2022

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Because Medicare beneficiaries can qualify for Medicaid through several pathways, duals who newly enroll in Medicaid may have experienced various financial and/or health changes that impact their Medicaid eligibility. Alternatively, new enrollment could reflect changes in awareness of the program among those previously eligible. Using monthly enrollment data linked to Health and Retirement Study survey data, we examine financial and health changes that occur around the time new Medicaid participants enter the program, and we compare those with changes experienced by both those continuously enrolled in Medicaid and those not enrolled. We find that Medicaid entry is often timed with a marked increase in out-of-pocket medical expenses, a substantial decrease in assets for some, and increases in activities of daily living (ADL) limitations. We also observe financial changes among persons continuously enrolled in Medicaid. Our results inform discussions about Medicaid eligibility policies and potential gaps in the protection that Medicaid offers from financial risk.

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Section: New Contributionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Examining Medicaid Participation and Medicaid Entry Among Senior Medicare Beneficiaries With Linked Administrative and Survey Data

et al. 2022

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“…Over recent decades, US long-term care policy has undergone a major shift toward home-and community-based services. 59,60 Still, access to these services remains limited and varies widely from state to state. [61][62][63] To investigate how these structural factors shape caregivers' health, we used an ecosocial theoretical framework, 64 longitudinal data from the Medical Expenditures Panel Survey (MEPS), and individual-level difference-in-difference models to assess the relationship between onset of Medicaid home care and family caregivers' health.…”

Section: Introductionmentioning

confidence: 99%

“…Only Medicaid-the means-tested public health insurance program-provides long-term home care services in the US; Medicare, the universal health insurance program for people aged 65 years or older or with disabilities, provides just limited, short-term services. 59,62,[65][66][67] We focused on publicly funded long-term care, rather than privatepaid care, because such programs can reduce caregivers' physical and emotional burden without increasing their financial burden. 65,[68][69][70][71] Little research has investigated how publicly funded home care affects caregivers, and existing studies do not assess caregiver health outcomes, are from outside the US, or compare home care to institutionalization rather than to continued stand-alone family caregiving.…”

Section: Introductionmentioning

confidence: 99%

Association Between New-Onset Medicaid Home Care and Family Caregivers’ Health

et al. 2021

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IMPORTANCE More than 17 million people in the US provide uncompensated care for adults with physical or cognitive limitations. Such caregiving is associated with worse mental and physical health, yet little research has investigated how publicly funded home care might ameliorate these harms. OBJECTIVE To investigate the association between Medicaid home care services and family caregivers' health. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study used data from the 1996 to 2017 Medical Expenditures Panel Survey. Data on all household members were collected in 5 interviews over 2 years. Person-level difference-in-difference models were used to isolate withinperson changes associated with new onset of Medicaid home care. The Medical Expenditures Panel Survey longitudinal data sets included 331 202 individuals (approximately 10% excluded owing to loss to follow-up). Adult (age Ն21 years) members of households that contained at least 1 person with limited activities of daily living were included in our study. The analysis itself was performed from March to August of 2020. EXPOSURES New onset of regular (Ն1 time per month) Medicaid home care in the household.MAIN OUTCOMES AND MEASURES Self-rated mental and physical health (planned prior to beginning the study). RESULTSThe study population was 14 013 adults; 7232 were "likely caregivers," or nondisabled adult coresidents of someone with activities of daily living limitations. Overall, 962 likely caregivers were ever exposed to Medicaid home care in the household; for 563, we observed the onset. Of likely caregivers exposed to Medicaid home care, 479 (50%) were women; 296 (31%) were White non-Hispanic, 309 (31%) were Hispanic or Latinx, and 279 (29%) were Black non-Hispanic individuals, respectively; 326 (34%) had less than a high school education; and 300 (31%) were in or near poverty. Median age of participants was 51 (interquartile range, 39-62) years. New-onset Medicaid home care was associated with a 0.08 standard deviation improvement in likely caregivers' self-rated mental health (95% CI, 0.01-0.14; P = .02) measured 1 to 6 months after onset, equivalent to a 3.39% improvement (95% CI, 0.05%-6.33%) over their average preonset mental health. No association with self-rated physical health was found (<0.001 standard deviations; 95% CI, −0.06 to 0.06; P = .99). CONCLUSIONS AND RELEVANCEIn this cohort study, Medicaid home care was associated with improvement in caregiver self-rated mental health, but not with any short-term change in self-rated physical health. When evaluating the social value of home care programs, policy makers should consider spillover benefits to caregivers.

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“…Medicaid is the predominant payor for NHs, covering approximately 63% of long-term residents (i.e., residents in NHs for over 100 days; Harris-Kojetin et al, 2016), whereas Medicare provides skilled nursing facility (SNF) coverage—up to 100 days—mainly for post-acute rehabilitative NH care. As of 2014, over 95% of U.S. NHs served long-term residents covered by Medicaid and short-term SNF residents (Centers for Medicare & Medicaid Services [CMS], 2015; Wiener et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Medicare Usage Changes in Nursing Homes and Their Impacts on Long-Stay Resident Outcomes

Lepore¹,

Daniel

2021

J Appl Gerontol

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Medicare provides skilled nursing facility (SNF) coverage for short-stay rehabilitation in nursing homes (NHs) at a better rate than Medicaid covers long-term NH care. National trends of increasing Medicare days culminated in 2010/2011 with a reduction to the SNF rates. Before the cuts, NHs that increased SNF days also improved outcomes for long-stay residents, including pain, pressure ulcer, and functional decline outcomes, suggesting spillover effects of SNF days. We replicated the prior study to determine how changes in SNF days and long-stay outcomes related following the rate cut. From 2011 to 2014, SNF days decreased and all three study outcomes improved. Spillover effects were not consistently observed. Decreasing SNF days was associated with increasing percentages of long-stay residents with daily pain and with decreasing percentages of long-stay residents getting pressure ulcers. Research on these associations in more recent years is needed to determine whether they persist and to inform practice.

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Financing Long-Term Services and Supports: Continuity and Change

Cited by 6 publications

References 10 publications

Examining Medicaid Participation and Medicaid Entry Among Senior Medicare Beneficiaries With Linked Administrative and Survey Data

Examining Medicaid Participation and Medicaid Entry Among Senior Medicare Beneficiaries With Linked Administrative and Survey Data

Association Between New-Onset Medicaid Home Care and Family Caregivers’ Health

Medicare Usage Changes in Nursing Homes and Their Impacts on Long-Stay Resident Outcomes

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