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Reducing Medicaid benefits or restricting eligibility would disproportionately affect nursing home stays of elderly blacks

Few elderly people covered by Medicaid have short-term recovery stays at nursing homes, which typically involve high-cost medical procedures that often are not reimbursed proportionally to nursing homes. Among elderly people, blacks are significantly less likely than whites to have recovery stays; Latinos are as likely as whites to have recovery stays. Both blacks and Latinos are as likely as whites to have terminal stays at nursing homes.

Medicaid coverage explains this difference because when it is taken into account, there is no significant difference in recovery stays between blacks and whites and still not much difference between Latinos and whites. Neither family income nor social support explained the observed racial differences in type of stay, according to a study supported jointly by the Agency for Healthcare Research and Quality and the National Institute on Aging (HS08034).

Since Medicaid coverage equalized recovery nursing home stays for blacks compared with whites, reductions in Medicaid benefits or restrictions in eligibility would negatively and disproportionately affect the nursing home stays of elderly blacks, conclude the researchers. They used data from the 1987 Institutional Population Component of the National Medical Expenditure Survey to identify factors that influenced the type of stay by various racial/ethnic groups. Recovery patients in general were less often poor and reliant on Medicaid and more often had private insurance in addition to Medicare.

All other factors being equal—such as health status and insurance—elderly blacks and Latinos were as likely as elderly whites to have recovery and terminal stays. Older individuals and females were more likely to have long stays, perhaps reflecting the frailty of the oldest of the old and the longer life expectancy of women. Those living in the West were the most likely to have recovery stays. Being poor did not affect type of stay in the presence of Medicaid coverage, while the existence of social support, such as children, reduced the likelihood of long-term stays. Of all the elderly, those covered by Medicaid prior to admission were 53 percent less likely to have recovery stays and 43 percent less likely to have terminal stays.

For details, see "Postadmission disparities in nursing home stays of whites and minority elderly," by Nadereh Pourat, Ph.D., Ronald Andersen, Ph.D., and Steven Wallace, Ph.D., in the Journal of Health Care for the Poor and Underserved 12(3), pp. 352-366.

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