Nursing home care under Medicaid managed long-term services and supports.

Publisher: Blackwell Country of Publication: United States NLM ID: 0053006 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1475-6773 (Electronic) Linking ISSN: 00179124 NLM ISO Abbreviation: Health Serv Res Subsets: MEDLINE

Publication: Malden, MA : Blackwell
Original Publication: Chicago, Hospital Research and Educational Trust.

Managed Care Programs/*statistics & numerical data ; Medicaid/*statistics & numerical data ; Nursing Homes/*statistics & numerical data ; Quality of Health Care/*trends; Humans ; Kansas ; Massachusetts ; Medicaid/organization & administration ; Nursing Care/statistics & numerical data ; Ohio ; Quality of Health Care/statistics & numerical data ; United States

Objective: To measure the impact of Medicaid managed long-term services and supports (MLTSS) on nursing home (NH) quality and rebalancing.
Data Sources/study Setting: This study analyzes secondary data from annual NH recertification surveys and the minimum dataset (MDS) in three states that implemented MLTSS: Massachusetts (2001-2007), Kansas and Ohio (2011-2017).
Study Design: We utilized a difference-in-difference approach comparing NHs in border counties of states that implemented MLTSS with a control group of NHs in neighboring border counties in states that did not implement MLTSS. Sensitivity analyses included a triple-difference model (stratified by Medicaid payer mix) and a within-state comparison. We examined changes in six NH-level outcomes (percentage of low-care NH residents, facility occupancy, and four NH quality measures) after MLTSS implementation.
Data Collection/extraction Methods: For each state, all freestanding NHs in border counties were included, as were NHs in neighboring counties located in other states. Information on low-care residents was aggregated to the NH level from MDS data, then combined with Online Survey Certification and Reporting (OSCAR) and Certification and Survey Provider Enhanced Reporting (CASPER) data.
Principal Findings: MLTSS had no statistically significant effects on NH quality outcomes in Massachusetts or Kansas. In Ohio, MLTSS led to an increase of 0.21 nursing hours per resident day [95% CI: 0.03, 0.40], and a decrease of 1.47 deficiencies [95% CI: -2.52, -0.42] and 9.38 deficiency points [95% CI: -18.53, -0.24] per certification survey. After MLTSS, occupancy decreased by 1.52 percentage points [95% CI: -2.92, -0.12] in Massachusetts, but increased by 3.17 percentage points [95% CI: 0.36, 5.99] in Ohio. We found no effect on low-care residents in any state. Findings were moderately sensitive to the choice of comparator group.
Conclusion: The study provides little evidence that MLTSS reduces quality of care, occupancy, or the percentage of low-care residents in NHs.
(© 2021 Health Research and Educational Trust.)

Health Serv Res. 2009 Oct;44(5 Pt 1):1521-41. (PMID: 19555397)
Disabil Health J. 2015 Jan;8(1):130-5. (PMID: 25281036)
Med Care Res Rev. 2020 Jun;77(3):274-284. (PMID: 29884092)
Age Ageing. 1997 Sep;26 Suppl 2:67-71. (PMID: 9464558)
Med Care Res Rev. 2006 Feb;63(1):3-28. (PMID: 16686071)
J Aging Soc Policy. 2013;25(2):146-60. (PMID: 23570508)
J Health Care Poor Underserved. 2019;30(3):968-985. (PMID: 31422983)
Med Care. 1994 Jul;32(7):668-85. (PMID: 8028403)
Health Aff (Millwood). 2007 Nov-Dec;26(6):1762-71. (PMID: 17978396)
Inquiry. 2015 Apr 16;52:. (PMID: 25882616)
J Aging Soc Policy. 2013;25(2):134-45. (PMID: 23570507)
Gerontologist. 2006 Aug;46(4):483-94. (PMID: 16921002)
J Aging Soc Policy. 2020 Mar-Apr;32(2):101-107. (PMID: 31347991)
Health Serv Res. 2021 Dec;56(6):1179-1189. (PMID: 34263450)
Health Serv Res. 2017 Oct;52(5):1729-1748. (PMID: 27581748)
J Policy Anal Manage. 2013;32(3):505-35. (PMID: 23814802)

Keywords: Medicaid; long-term services and supports; managed care; nursing home quality; rebalancing

Date Created: 20210715 Date Completed: 20211207 Latest Revision: 20221202

20250114

PMC8586477

10.1111/1475-6773.13701

34263450