Pulse development · 2 cited sources · September 14, 2026
The proportion of Medicaid residents in nursing homes significantly decreased.
A six-state study found nursing-home changes after mandatory MLTSS, while an AARP review identifies what community care needs to work locally.
In six states that implemented mandatory statewide Medicaid managed long-term services and supports between 2010 and 2014, nursing homes changed during the five years after implementation. A new study found a curvilinear decline in the proportion of Medicaid residents, a curvilinear increase in the proportion of residents with other payer sources, and a monotonic rise in total nurse hours per resident day. The total number of nursing-home residents did not change significantly. For families deciding whether care can work at home, these changes show a facility-level shift; the study says they potentially reflect diversion of Medicaid beneficiaries from nursing homes.
The study found suggestive evidence of a transitory increase in CNA HPRD. It also reports that no single nursing staff category increased enough to account for the rise in total HPRD, while cumulative modest gains across categories appear to explain it. Those staffing results matter for residents still in nursing homes. The resident-mix pattern, however, is presented as potentially reflecting diversion rather than as a measure of the care a household receives after leaving a nursing home.
AARP Public Policy Institute and ATI Advisory reviewed more than 60 community-based care models and profiled three programs in Arizona, North Dakota, and Texas. The organizations say many older adults fall between private-pay long-term care they cannot afford and Medicaid coverage they do not qualify for, a gap that can increase reliance on family caregivers. Their report identifies a focused service model, workforce and delivery capacity, operational infrastructure, sustainable funding, trusted community relationships, and local fit as replication conditions. Together, the sources support a household test: care at home must be reachable, financed, and deliverable in a particular community.
Evidence
Each statement shown below is a verified claim this source supports.
- Following mandatory statewide MLTSS implementation, the proportion of Medicaid residents in nursing homes significantly decreased.
- A study examined nursing homes in six states that implemented mandatory statewide MLTSS between 2010 and 2014.
- Following mandatory statewide MLTSS implementation, the proportion of nursing-home residents with other payers significantly increased.
- During the five years following mandatory statewide MLTSS implementation, total nurse hours per resident day rose monotonically.
- The total number of nursing-home residents did not change significantly.
- The authors say the findings potentially reflect diversion of Medicaid beneficiaries from nursing homes.
- The study found suggestive evidence of a transitory increase in CNA HPRD.
- No single nursing staff category increased enough to account for the rise in total HPRD.
- The authors say the rise in total HPRD appears to result from cumulative modest gains across staffing categories.
- AARP Public Policy Institute and ATI Advisory identify six domains communities can use to support model replicability: a focused service model, workforce and delivery capacity, operational infrastructure, sustainable funding, trusted community relationships, and local fit.
- AARP Public Policy Institute and ATI Advisory conducted a landscape review of more than 60 community-based care models.
- The AARP Public Policy Institute and ATI Advisory report profiles three community-based care programs in Arizona, North Dakota, and Texas.
- AARP Public Policy Institute and ATI Advisory say many older adults fall between private-pay long-term care they cannot afford and Medicaid coverage they do not qualify for.
- AARP Public Policy Institute and ATI Advisory say that this gap often increases reliance on family caregivers.
Developments in this issue