摘要：We used fixed-effect models to examine the relationship between local spending on home- and community-based services (HCBSs) for cash-assisted Medicaid-only disabled (CAMOD) adults and younger adult admissions to nursing homes in the United States during 2001 through 2008, with control for facility and market characteristics and secular trends. We found that increased CAMOD Medicaid HCBS spending at the local level is associated with decreased admissions of younger adults to nursing homes. Our findings suggest that states’ efforts to expand HCBS for this population should continue. Since the 1999 Olmstead decision, 1 there has been a number of initiatives aimed to provide individuals with disabilities increased access to long-term care (LTC) options, primarily through expansion in home- and community-based services (HCBSs). Although research has investigated the effect of HCBS growth on the Medicare population of nursing home residents, 2–9 there has been little attention given to the relationship between younger nursing home residents and Medicaid HCBS expenditures. As states face growing pressure in how to best allocate their Medicaid budgets, it is important that we have sound research guiding these decisions. Recently, a published study suggested that younger adults’ rates of nursing home admission were not related to Medicaid HCBS spending. 10 Two prominent limitations may have led to this null finding: (1) rather than measuring spending for younger adults, the 2011 study used total state Medicaid LTC spending, and (2) the analyses were conducted at the state level, thereby missing market and facility characteristics influencing this relationship. We reexamined this question by using more refined data: Medicaid LTC spending on cash-assisted Medicaid-only disabled (CAMOD) adults at the local level and nursing home admission assessment data aggregated to the facility level. We hypothesized that increasing investment in Medicaid HCBSs for CAMOD adults would be related to a decrease in the share of younger adult nursing home admissions.
