Importance
New York State's Medicaid managed long-term care (MLTC) program expanded access to
home- and community-based services, providing an alternative to nursing home care for people with
dementia. Between 2012 and 2015, the state implemented mandatory MLTC for dual Medicare and Medicaid
enrollees requiring more than 120 days of community-based long-term care.
Objective
To evaluate changes in nursing home use among older adults with dementia following MLTC implementation.
Design, Setting, and Participants
This cohort study used longitudinal data from January 1, 2011, to
December 31, 2019, from the Minimum Data Set and Medicare administrative data. The study sample
included New York State Medicare beneficiaries 65 years and older with dementia. New York City
residents were excluded due to insufficient pre-study period data. Data were analyzed from January
1, 2011, to December 31, 2019.
Exposure
Mandatory MLTC enrollment.
Main Outcomes and Measures
Longitudinal models were used to evaluate changes in annual days of nursing home use following the
staggered implementation of MLTC across 13 regions of the state. Two models were estimated: (1) a
logistic regression model for any nursing home use in a given year and (2) a linear regression model
of total nursing home days, conditional on any nursing home use. Models included annual event-time
indicators specified as years until or since MLTC implementation. To capture MLTC effects for dual
enrollees relative to non-dual Medicare enrollees, models included interaction terms for dual
enrollment and event-time indicators.
Results
This sample included 463,947 Medicare beneficiaries
with dementia who lived in New York State between 2011 and 2019 (50.2% younger than 85 years; 64.4%
women). Implementation of MLTC was associated with lower odds of nursing home use among dual
enrollees, ranging from 8% lower odds 2 years post implementation (adjusted odds ratio, 0.92 [95%
CI, 0.86-0.98]) to 24% lower odds 6 years post implementation (adjusted odds ratio, 0.76 [95% CI,
0.69-0.84]). Compared with a scenario of no MLTC, MLTC implementation was associated with an 8%
reduction in annual days of nursing home use between 2013 and 2019 (mean, -5.6 [95% CI, -6.1 to
-5.1] days per year).
Conclusions and Relevance
The findings of this cohort study suggest that
implementation of mandatory MLTC in New York State was associated with less nursing home use among
dual enrollees with dementia and that MLTC may help prevent or delay nursing home placement among
older adults with dementia.