Nursing Home Admissions Among Medicaid HCBS Enrollees Evidence of Racial/Ethnic Disparities or Differences?

Objectives:Rebalancing the long-term care system between institutional care and home-based and community-based services (HCBS) has become an important policy goal of most state Medicaid programs and several provisions of the Affordable Care Act. This study estimated nursing home admission patterns by race and ethnicity in a retrospective cohort of Medicare and Medicaid dually eligible individuals who enrolled in Medicaid HCBS programs.Study Design:We analyzed the 2006 Medicaid Analytic eXtract personal summary files from 19 states, and linked these data to nursing home Minimum Data Sets and other files. We used multivariable competing risk proportional hazard models to estimate 2-year risks of short-term and long-term nursing home admissions for black and Hispanic HCBS enrollees, compared with white enrollees. We also compared racial/ethnic differences in physical and cognitive impairments at the time of nursing home admissions.Results:Among 93,508 older (65 y and above) and new HCBS users, the 2-year long-term nursing home admission rates were 10.16% for blacks [n=18,000; hazard ratio (HR)=0.80, P<0.001 in multivariable regression] and 5.59% for Hispanics (n=13,786; HR=0.49, P<0.001), compared with 12.27% for whites. The 2-year short-term nursing home admission rates were 11.99% for blacks (HR=0.84, P<0.001 in multivariable regression) and 9.29% for Hispanics (HR=0.62, P<0.001), compared with 13.40% for whites. Black and Hispanic elders were more impaired than whites in physical and cognitive functions at both short-term and long-term nursing home admissions.Conclusions:Among dual-eligible older HCBS recipients, blacks and Hispanics tended to stay longer in their communities until a nursing home admission, and upon admission, are more impaired both physically and cognitively. These differences may suggest continued racial/ethnic disparities in access to nursing homes in addition to cultural differences in long-term care preferences.