The Impact of Medicaid Managed Long-Term Services and Supports on Nursing Home Staffing and Care Diversion: A Staggered Difference-In-Differences Approach.

State governments have increasingly adopted Medicaid managed long-term services and supports (MLTSS) programs. Drawing on data from nursing homes in six states that implemented mandatory statewide MLTSS between 2010 and 2014, this study examines MLTSS impacts on care diversion and staffing. A staggered difference-in-differences event study framework is used to capture dynamic effects over time after MLTSS implementation. Results indicate 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, during the five years following mandatory statewide MLTSS implementation. We find suggestive evidence of a transitory increase in CNA HPRD. Given no significant change occurred in the total number of nursing home residents, findings suggest a shift in resident composition, potentially reflecting diversion of Medicaid beneficiaries from nursing homes. Moreover, because no single nursing staff category experienced an increase large enough to account for the rise in total HPRD, the observed linear increase appears to result from cumulative modest gains across staffing categories. This multistate study offers robust new evidence on the effects of MLTSS over the five-year period following mandatory statewide implementation.