Estimating the Extent of Medicaid Spend-Down in Nursing Homes

Although it is commonly thought that a very high proportion of private-pay nursing home patients become eligible for Medicaid during their stay, few national studies have been conducted to determine the extent of Medicaid “spend-down.” The discharged resident survey of the 1985 National Nursing Home Survey was analyzed to determine the extent of spend-down among elderly nursing home patients during a single nursing home episode, the proportion of patients who remained Medicaid or private payers throughout their stay, and how the measures varied by patient characteristics. Overall, during a single nursing home episode only 10 percent of nursing home patients who entered as private payers received Medicaid at discharge. Roughly one-third of nursing home patients remained on Medicaid throughout their stay, and another third remained private payers throughout their stay.