May 16: Brown Bag talk by Thomas Rapp on the Impact of State Medicaid Generosity for Home- and Community-Based Services on Nursing Home Entry

On May 16th at 11 am, the Columbia Aging Center welcomes Thomas Rapp, PhD, Harkness fellow at Harvard's School of Public Health in the Department of Health Policy and Management.  Dr. Rapp's talk "Impact of State Medicaid Generosity for Home- and Community-Based Services on Nursing Home Entry" will be held in ARB Room 416. Please RSVP to cmh2197@columbia.edu if you wish to attend this talk by Thomas Rapp on Monday, May 16th at 11 a.m. in ARB Room 416, 722 West 168th Street.

Historically, U.S. states have dedicated most of their Medicaid long-term services and supports (LTSS) expenditures to nursing homes. Since the 1990’s, a key aspect of U.S. policy for disabled elders has been to shift state Medicaid expenditures away from institutional nursing home care and towards home- and community-based services (HCBS). In 2010, the Affordable Care Act (ACA) enhanced that effort with the Balancing Incentive Program (BIP), providing Federal-matching contributions to selected states that increased their HCBS Medicaid expenditures. In spite of the ACA emphasis on encouraging greater HCBS, less is known about the impact of increased HCBS investment on elderly Medicaid beneficiaries’ care pathways. Dr. Rapp's research in collaboration with David C. Grabowski, PhD, explores the impact of state Medicaid HCBS investment on the elderly beneficiaries’ risks of nursing home admission using four waves of the Health and Retirement Study (2006-2013). Using a simulated instrumental variable of Medicaid eligibility, they found that increased state spending in HCBS reduced the risk of nursing home entry for Medicaid recipients relative to non-Medicaid recipients. Specifically, they found that for a $1 increase in state per capita HCBS spending for older people and people with disabilities, the difference in nursing home admission risks observed between Medicaid and non-Medicaid elders is reduced by 0.002% points on average.