Outcomes of Medicaid Rebalancing May Differ Across Enrollee Populations

Access to home- and community-based services (HCBS) may prevent or delay nursing home transitions among older adults. Medicaid’s Balancing Incentive Program (BIP) (2011–2015) provided assistance for U.S. states to increase access to HCBS through infrastructure changes and spending benchmarks. We combined longitudinal data from the 2008–2019 Medicare Current Beneficiary Survey and Minimum Data Set and used survival modeling to examine the association between BIP exposure (living in a BIP-participant state vs. not) and time to long-term institutionalization (LTI, defined as a nursing home episode of 90+ days) among dual enrollees ages 65 and older. In the main effects model, BIP exposure was not associated with hazard of LTI. Interaction models showed that BIP exposure was associated with a lower hazard of LTI among Hispanic/Latinx enrollees, while the opposite was true among non-Hispanic White enrollees. Our findings suggest the outcomes of Medicaid rebalancing efforts may differ across enrollee subgroups.