Teresa A. Coughlin

Predicting Nursing-Home Admission and Length of Stay: A Duration Analysis

Information on who enters nursing homes and how much nursing-home care people use continues to be important for the consideration of various long-term care policies. Research on how characteristics of noninstitutionalized disabled elderly persons are related to both risk of admission and length of stay is presented here. Hazard models were developed using data from the 1982-84 National Long-Term Care Survey. Personal characteristics of elderly persons and state policy variables had varying effects on nursing-home use in a 2-year period.

Determinants of Transitory and Permanent Nursing Home Admissions

This article describes an analysis of data from the 1982-84 National Long-Term Care Demonstration Project to estimate the risks of any nursing home admission, a temporary or transitory admission, and a permanent admission. Using a multinomial logit model, the relative predictive power of several individual characteristics on nursing home use and admission type were evaluated. It was found that the cognitively impaired subgroup was at the greatest risk of entering a nursing home, especially on a permanent basis. The results also demonstrated that the combination of cognitive impairment and functional impairment further increased the risk of a nursing home admission, particularly a permanent one. Other subgroups that had high probabilities of experiencing a nursing home admission were whites, nonhomeowners, those living alone, and those with prior nursing home stays. The findings identified several aged subgroups that were at no greater risk of nursing home admission regardless of admission type: older persons who were unmarried, had a low income, had no assets, and those on Medicaid.

Risk of entering nursing homes for long versus short stays.

Research on the risk of nursing home use has generally not distinguished between risk for long versus short stays. This paper presents an analysis of data from the 1982–84 National Long-Term Care Surveys to identify characteristics of disabled persons that predicted one or the other type of stay. Measures that are recognized to be strong predictors of nursing home use in general, such as dependencies in activities of daily living and cognitive impairment, were not significantly associated with admission for short stays. Results from the multivariate analysis were also used to make projections of lifetime risk of long and short stays. Approximately one-third of lifetime nursing home risk applies to stays of 90 days or less.

Among Dual Eligibles, Identifying The Highest-Cost Individuals Could Help In Crafting More Targeted And Effective Responses

The nearly nine million people who receive Medicare and Medicaid benefits, known as dual eligibles, constitute one of the nations most vulnerable and costly populations. Several initiatives authorized by the Affordable Care Act are intended to improve the health care delivered to dual eligibles and, at the same time, to achieve greater control of spending growth for the two government programs. We examined the 2007 costs and service use associated with dual eligibles. Although the population is indeed costly, we found nearly 40 percent of dual eligibles had lower average per capita spending than non-dual-eligible Medicare beneficiaries. In addition, we found that about 20 percent of dual eligibles accounted for more than 60 percent of combined Medicaid and Medicare spending on the dual-eligible population. But even among these high-cost dual eligibles, we found subgroups. For example, fewer than 1 percent of dual eligibles were in high-cost categories for both Medicare and Medicaid. These findings suggest that decision makers should tailor reform initiatives to account for subpopulations of dual eligibles, their costs, and their service use.

Florida’s Medicaid Reform: Informed Consumer Choice?

Florida is among the first states to implement Medicaid reform using a competitive consumer choice model. Using data from a 2006-07 Kaiser Family Foundation survey of Medicaid recipients newly enrolled in Floridas reform program, we examine how well they understood the changes taking place and their experiences in selecting a health plan. We find important gaps in peoples understanding of major components of the reform: About 30 percent were not aware that they were enrolled in reform, and more than half had trouble understanding plan information. These problems were not particular to any group but instead were experienced broadly across the full Medicaid population.

The Expansion of Medicaid Coverage under the ACA: Implications for Health Care Access, Use, and Spending for Vulnerable Low-income Adults

The expansion of Medicaid coverage under the Affordable Care Act offers the potential for significant increases in health care access, use, and spending for vulnerable nonelderly adults who are uninsured. Using pooled data from the Medical Expenditure Panel Survey, this study estimates the potential effects of Medicaid, controlling for individual and local community characteristics. Our findings project significant gains in health care access and use for uninsured adults who enroll in Medicaid coverage and have chronic health conditions and mental health conditions. With that increased use, annual per capita health care spending for those newly insured individuals (excluding out-of-pocket spending) is projected to grow from

Does managed care improve access to care for Medicaid beneficiaries with disabilities? A national study.

2,677 to

Commercial Health Plan Participation in Medicaid Managed Care: An Examination of Six Markets

6,370 in 2013 dollars, while their out-of-pocket spending would drop by

State Responses to the Medicaid Spending Crisis: 1988 to 1992

921. It is expected that these increases in spending would be offset at least in part by reductions in uncompensated care and charity care.

The Health Care Experiences of Rural Medicaid Beneficiaries

States increasingly are shifting Medicaid beneficiaries with disabilities from the fee-for-service (FFS) delivery system to managed care in an effort to control program costs and address long-standing problems with access to care under the program. Using a county-based measure of managed care enrollment and pooled data from the 1997 to 2004 National Health Interview Surveys, we investigate whether Medicaid managed care (MMC), relative to FFS Medicaid, improves access to care. We find some evidence of improved access to care under MMC; however, the gains appear to be largely limited to beneficiaries in urban areas with fully capitated managed care. There is little evidence of improved access under primary care case management or, regardless of MMC type, in rural areas.