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) |
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| 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% | $232,784 | 30% | √ | |
| Delaware | 156,200 | 16% | 24,600 | 9% | 2,043 | 60% | $272,899 | 49% | √ | |
| 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). |
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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.