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Medicaid’s Role in Nursing Home Care

 Table 1: Medicaid’s Role in Nursing Home Care, by State
State Residents Age 65+
(2015)
Medicaid Enrollees Age 65+ (FY 2014) Certified Nursing Facility Residents with Medicaid
(2015)
Nursing Home Care Spending (FY 2015) State Covers LTC Needs Up to 300% SSI
(2015)
Number of State Residents Share of State Population Number Percent of Total Medicaid Enrollees Number of Residents Share of Total Nursing Facilities Residents Amount Share of Total Medicaid LTC Spending
United States 47,546,500 15% 7,379,600 9% 832,460 62% $54,832,318 35% 44
Alabama 713,400 15% 140,800 11% 15,252 67% $944,141 53%
Alaska 79,500 11% 10,300 7% 490 79% $181,745 32%
Arizona 1,035,000 15% 128,500 8% 6,812 59% $448,951 27%
Arkansas 456,000 15% 74,100 8% 11,605 66% $661,360 33%
California 5,075,800 13% 1,205,200 8% 62,299 62% $3,250,424 24%
Colorado 759,400 14% 102,400 8% 9,899 61% $694,011 33%
Connecticut 554,300 16% 129,100 14% 16,438 69% $1,197,886 36%
District of Columbia 87,300 13% 15,500 7% 2,550 80% $272,899 49%
Delaware 156,200 16% 24,600 9% 2,043 60% $232,784 30%
Florida 3,757,100 19% 610,500 13% 41,813 57% $3,472,597 59%
Georgia 1,298,000 13% 195,900 9% 23,822 72% $1,289,089 50%
Hawaii 231,200 17% 29,800 9% 2,228 63% $287,794 58%
Idaho 252,100 15% 22,700 7% 2,369 64% $266,129 41%
Illinois 1,881,700 15% 275,100 8% 39,514 57% $1,428,479 29%
Indiana 1,010,000 16% 103,600 8% 24,337 62% $2,006,714 57%
Iowa 486,700 16% 46,800 7% 11,552 48% $623,815 29%
Kansas 397,000 14% 41,100 9% 9,494 53% $525,010 43%
Kentucky 723,100 16% 99,100 8% 15,588 67% $957,640 49%
Louisiana 598,700 13% 123,100 9% 19,149 74% $963,115 42%
Maine 275,400 21% 64,500 18% 3,935 64% $277,016 28%
Maryland 776,700 13% 107,400 8% 15,036 61% $1,174,675 38%
Massachusetts 1,031,500 15% 200,500 10% 24,743 61% $1,814,969 27%
Michigan 1,656,100 17% 159,600 6% 23,428 60% $1,782,637 55%
Minnesota 890,600 16% 123,400 9% 13,404 52% $780,647 17%
Mississippi 424,700 14% 92,800 12% 12,017 75% $761,814 48%
Missouri 921,000 15% 88,500 8% 24,239 63% $1,068,006 32%
Montana 182,600 18% 17,800 10% 2,563 58% $165,541 35%
Nebraska 267,800 14% 28,300 10% 6,111 52% $340,032 41%
Nevada 413,100 14% 51,500 8% 2,789 58% $214,753 35%
New Hampshire 206,800 16% 14,800 8% 4,249 64% $341,826 42%
New Jersey 1,323,400 15% 161,800 10% 26,676 59% $1,759,936 36%
New Mexico 342,300 17% 67,200 8% 3,679 66% $260,091 19%
New York 3,146,000 16% 711,400 11% 69,694 67% $6,882,589 30%
North Carolina 1,386,200 14% 222,200 10% 23,370 64% $1,179,921 39%
North Dakota 111,600 15% 7,500 8% 2,855 51% $266,606 45%
Ohio 1,730,400 15% 204,600 7% 44,549 59% $2,786,965 39%
Oklahoma 554,100 14% 68,200 7% 12,143 65% $577,093 41%
Oregon 615,500 15% 74,800 7% 4,179 56% $388,305 17%
Pennsylvania 2,169,500 17% 267,700 10% 49,375 63% $3,848,905 43%
Rhode Island 162,700 16% 24,500 8% 4,964 63% $361,594 41%
South Carolina 793,500 17% 107,800 8% 10,084 60% $583,852 38%
South Dakota 131,700 16% 13,000 9% 3,252 52% $138,775 42%
Tennessee 1,053,600 16% 149,400 10% 16,653 60% $1,096,127 42%
Texas 3,345,400 12% 479,600 9% 57,157 61% $2,640,412 28%
Utah 326,700 11% 18,500 4% 2,735 51% $190,765 34%
Vermont 102,400 17% 22,800 11% 1,667 64% $121,984 30%
Virginia 1,186,900 14% 114,600 11% 16,433 59% $948,887 31%
Washington 1,158,500 16% 113,900 6% 10,006 59% $644,037 22%
West Virginia 343,500 19% 45,300 8% 7,122 76% $606,591 41%
Wisconsin 879,900 15% 171,000 12% 14,728 55% $1,059,237 30%
Wyoming 83,600 15% 6,400 7% 1,411 62% $103,148 39%
NOTES: Governor party affiliation and Medicaid expansion status as of 2017.
SOURCE: Kaiser Family Foundation estimates based on the Census Bureau’s March 2016 Current Population Survey (CPS: Annual Social and Economic Supplement). KFF estimates based on analysis of data from the 2014 Medicaid Statistical Information System (MSIS). For states with fewer than for quarters of MSIS data, we also adjusted enrollment using secondary data (specifically, the Medicaid Budget and Expenditure System) to represent a full fiscal year of enrollment. We accounted for a state’s expansion status, the number of quarters of missing data, and the state’s historical patterns of enrollment in making state-by-state adjustments. Due to these adjustments, enrollment estimates here may not match other analysis based on the MSIS data or state’s own reporting systems. Harrington, Carrillo, and Garfield, based on OSCAR/CASPER Data. Truven, Medicaid Expenditures for Long-Term Services and Supports (LTSS) in FY 2015, April 14, 2017. KCMU Medicaid Financial Eligibility Survey for Seniors and People with Disabilities (2015).

Sources

University of California, San Francisco and Kaiser Family Foundation analysis of On-line Survey, Certification, and Reporting system (OSCAR) and Certification and Survey Provider Enhanced Reports (CASPER) data.

Charlene Harrington, James H Swan, and Helen Carrillo, “Nursing Staffing Levels and Medicaid Reimbursement Rates in Nursing Facilities,” Health Research and Educational Trust 42, 3, Part I (June 2007): 1105-1129, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955251/pdf/hesr0042-1105.pdf.

Genworth Financial, Annual Median Cost of Long Term Care in the Nation, 2016, (Genworth Financial, 2017), https://www.genworth.com/corporate/about-genworth/industry-expertise/cost-of-care.html.

Gretchen Jacobson, Shannon Griffin, Tricia Newman, and Karen Smith, Income and Assets of Medicare Beneficiaries, 2016-2035, (Washington, DC: Kaiser Family Foundation, April 2017), http://www.kff.org/medicare/issue-brief/income-and-assets-of-medicare-beneficiaries-2016-2035/.

Kaiser Family Foundation estimates based on the Census Bureau’s March 2016 Current Population Survey (CPS: Annual Social and Economic Supplement).

Kaiser Family Foundation estimates based on 2015 National Health Expenditure Accounts data from CMS, Office of the Actuary and Kaiser Family Foundation estimates based on analysis of data from FY 2013 MSIS and Urban Institute estimates from CMS-64 reports. Because CO and RI data were unavailable in 2013, used data from earlier years aligned to 2013 CMS-64. Individuals who used both institutional and community-based services in the same year are classified as using institutional services.

KCMU Medicaid Eligibility Survey for Seniors and People with Disabilities (2015)

National Center for Health Statistics (NCHS), Long-Term Care Providers and Services Users in the United States – State Estimates Supplement: National Study of Long-Term Care Providers, 2013-2014, (Rockville, MD: NCHS, 2016), https://www.cdc.gov/nchs/data/nsltcp/2014_nsltcp_state_tables.pdf.

Peter Kemper, Harriet L Komisar, and Lisa Alecxih, “Long-Term Care over an Uncertain Future: What can Current Retirees Expect?”, Inquiry 42, (Winter 2005/2006):335-350.

Truven Analytics, Medicaid Expenditures for Long-Term Services and Supports (LTSS) in FY 2015, (Ann Arbor, Michigan: Truven, April 2017), https://www.medicaid.gov/medicaid/ltss/downloads/reports-and-evaluations/ltssexpendituresffy2015final.pdf.

U.S. Census Bureau, Population Division, Table 3: Projections of the Population by Sex and Selected Age Groups for the United States: 2015 to 2060 (NP2014-T3), December 2014.

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