Medicaid Expansion and Nursing Homes Through the Lens of U.S. Rural Communities

There is a growing population of adults under 65 with disabilities needing to access long-term care (LTC). Rural areas are seeing this population rise while also experiencing growing nursing home closures. Medicaid, the largest payer of LTC, already pays for more LTC in rural areas than in urban areas. Therefore, state Medicaid expansion may increase insurance coverage for newly eligible individuals needing to use rural nursing homes. Using LTC Focus from 2011-2019, this paper conducts a Callaway Sant'Anna Difference-in-Differences analysis to understand the impacts of Medicaid expansion on rural nursing home admission demographics. Results indicated no significant effect of expansion on the percentage of Medicaid-dependent admissions and the percentage of under-65 admissions. Expansion was associated with a decrease in the percentage of admissions accounted for by Black individuals (-0.97** CI: -1.62, -0.33) in the included counties. More research must be conducted to study why the percent of Black admissions declined.