Predictors of Nursing Facility Entry by Medicaid-Only Older Adults and Persons With Disabilities in California. (9th April 2018)

• Record Type: Journal Article
• Authors: Ko, Michelle; Newcomer, Robert J.; Harrington, Charlene; Hulett, Denis; Kang, Taewoon; Bindman, Andrew B.
• Is Part Of: Inquiry. Volume 55(2018)
• Publication Date: 2018-04-09
• Subjects: Medicaid -- long-term services and supports -- home and community-based services -- skilled nursing facilities; Medical policy -- United States -- Periodicals; Medical care, Cost of -- United States -- Periodicals; Hospitalization insurance -- United States -- Periodicals; 362.10973
• DOI: 10.1177/0046958018768316
• Languages: English
• ISSNs: 0046-9580

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.