Impact of Managed Long-Term Services and Supports on Nursing Home Use

States have increased their use of managed care organizations to cover long-term services and supports (LTSS) to rebalance use from nursing homes to home and community-based settings. We study the impact of managed long-term services and supports (MLTSS) programs on long-stay Medicaid nursing home visits.

We used the minimum data set (MDS) 3.0 and master beneficiary summary files (MBSF) from 2011 to 2021 to identify 3,685,771 older adults aged 65 and above with long-stay nursing home visits. Using a staggered difference-in-differences (DiD) regression design, we compared individuals in states that implemented MLTSS programs with individuals in states that did not implement MLTSS.

Although overall Medicaid nursing home enrollment for older adults decreased from 2011 to 2021, states implementing MLTSS experienced a 5.83% decrease in their share of older adults residing in long-stay nursing homes relative to states that did not implement MLTSS. We observed no significant changes in the share of residents with low care needs due to MLTSS.

The findings of this study suggest MLTSS programs can potentially fulfill states' objectives of rebalancing Medicaid LTSS use from nursing homes to home and community-based settings, but further design changes may be necessary to target low-care nursing home residents.