Asset Transfer and Nursing Home Use: Empirical Evidence and Policy Significance

Due to concern that wealthy elderly Americans were transferring assets to gain Medicaid coverage for nursing home care, the Deficit Reduction Act (DRA) of 2005 tightened Medicaid eligibility rules related to asset transfers. About 43 percent of all nursing home residents eventually become Medicaid eligible.

This brief concludes that for people becoming Medicaid eligible at the time of nursing home admission, 50 percent had asset (cash and deed) transfers of less than $5,000. Conversely, only 13 percent of people who became Medicaid eligible at admission transferred more than $50,000. Asset transfer patterns were most common among nursing home residents who did not receive Medicaid assistance, with over 50 percent of the group making a transfer. Over the six-year period examined, the authors estimate that, when applying the DRA asset transfer rules, federal savings to Medicaid could amount to $1.87 billion.

Issue Brief (.pdf)

This brief presents new information on the distribution of Medicaid spending for all enrollees, including those residing in institutions. The analysis finds that fewer than five percent of enrollees (each exceeding $25,000 in annual costs) account for almost half of all Medicaid spending.

Issue Brief (.pdf)

Home Transition Programs: Perspectives of Medicaid Care Planners

This report draws on interviews with Medicaid care planners for insight into the issues that arise in establishing programs to move individuals with significant long-term care needs from institutional to community settings. The five states that participated in this study—Florida, Louisiana, New Jersey, Ohio and Washington—each received federal grants for nursing home transition activities and had varied experiences.

Report (.pdf)

Nursing Home Transition Programs: Perspectives of State Medicaid Officials

This report draws on interviews with state Medicaid program officials for insight into the issues that arise in establishing programs to move individuals with significant long-term care needs from institutional to community settings. The five states that participated in this study—Florida, Louisiana, New Jersey, Ohio and Washington—each received federal grants for nursing home transition activities and had varied experiences.

Report (.pdf)

The Deficit Reduction Act of 2005 (DRA) was signed by the President in February 2006 and included major changes to the Medicaid program. This brief provides an overview of the changes to the rules and direction of Medicaid long-term care services as enacted in the DRA.

Issue Brief (.pdf)

This study of Medicare Part D plans offered in 2006 examines formularies, drug costs and utilization management tools in drug plans offered by 14 national and near-national organizations. Collectively, these organizations account for 1,222 of the 1,429 Part D plans available to Medicare beneficiaries.

The analysis finds that Medicare’s new, private, stand-alone drug plans vary significantly in terms of covered drugs, out-of-pocket costs for specific medications and restrictions placed on the use of certain drugs.

The study was conducted by Jack Hoadley of Georgetown University, Elizabeth Hargrave of NORC at the University of Chicago, and Juliette Cubanski and Tricia Neuman of the Kaiser Family Foundation.

News Release

Report (.pdf)

The Deficit Reduction Act (DRA) of 2005, which became law this February, includes several significant changes to Medicaid long-term care policies. The Kaiser Family Foundation’s Commission on Medicaid and the Uninsured is releasing five new reports on long-term care issues that were addressed by the DRA changes.

Long-term care accounts for 36 percent of Medicaid spending (over $100 billion annually) and is utilized by many of Medicaid’s most costly beneficiaries, the low-income elderly and individuals with disabilities.

Medicaid Long-Term Services Reforms in the Deficit Reduction Act

Asset Transfer and Nursing Home Use: Empirical Evidence and Policy Significance

Beyond Cash and Counseling: An Inventory of Individual Budget-based Community Long-Term Care Programs

Nursing Home Transition Programs: Perspectives of State Medicaid Officials

Home Transition Programs: Perspectives of Medicaid Care Planners

Medicaid and the State Children’s Health Insurance Program (SCHIP) are often compared because they both serve low-income populations. However, the populations served, the coverage offered and the structure of these programs have differed in important ways. With the passage of the Deficit Reduction Act of 2005, states can now apply some SCHIP-like principles to the Medicaid program. Moreover, SCHIP is due for reauthorization by Congress after fiscal year 2007.

This issue brief examines the similarities and difference between Medicaid and SCHIP as well as the implications of applying some SCHIP design features to the Medicaid program.

Issue Brief (.pdf)

Do you think the government in Washington should guarantee medical care for all people who don’t have, health insurance or isn’t this the responsibility of the government in Washington?

65% Should

27 Not government responsibility

8 Don’t know/No answer

Methodology: Conducted by CBS News/New York Times, September 16-September 19, 1993 and based on telephone interviews with a national adult sample of 1,136. Data provided by The Roper Center for Public Opinion Research, University of Connecticut.

Do you think the government in Washington should guarantee medical care for all people who don’t have, health insurance or isn’t this the responsibility of the government in Washington?

77%  Should

17   Not government responsibility

6    Don’t know/No answer

Methodology: Conducted by CBS News/New York Times, June 17-June 20, 1992 and based on telephone interviews with a national adult sample of 1,315.   Data provided by The Roper Center for Public Opinion Research, University of Connecticut.