Medicaid-Financed Institutional Services: Characteristics of Nursing Home and ICF/IID Residents and Their Patterns of Care

Publisher: Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy
Aug 30, 2013
Jeffrey Ballou, Valerie Cheh, Dean Miller, and Audra Wenzlow
  • Among Medicaid enrollees with institutional stays of six months or less, 30 percent used HCBS prior to receiving nursing home services, whereas more than one in four used HCBS following discharge.
  • Although the percentage of nursing home stays lasting three months or less was generally higher in states with larger investments in HCBS than in nursing homes and with higher HCBS utilization rates, these associations were not especially large.
  • Fewer older adults and people with disabilities were enrolled in Medicaid in 2006–2007 than in 2001–2002, and fewer of these people had either new or ongoing nursing home stays. The percentage of this population receiving care in nursing homes declined slightly in states that allocated a high proportion of their Medicaid LTC expenditures to HCBS, while rising slightly in others.
  • More than 40 percent of enrollees living in ICFs/IID used HCBS before their ICF/IID stay, suggesting that it is not uncommon for an individual to use both community and institutional services rather than solely ICF/IID services.



To better understand the population of Medicaid enrollees living in nursing homes or intermediate care facilities for individuals with intellectual disabilities (ICFs/IID), researchers analyzed data from the Medicaid Analytic eXtract (MAX) from 2006 and 2007 to determine the characteristics of enrollees remaining in nursing homes and ICFs/IID and their stays and assess how the length of institutional stays varies at the state level with changes in state constraints and policies. More specifically, the report explored the use of home and community-based services (HCBS) both before and after institutional stays and whether the length of institutional stays throughout a state corresponded to the percentage of Medicaid long-term care (LTC) spending the state allocated to HCBS.