Abstract
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.