Over the past two decades, nursing homes and home health care agencies have been influenced by several Medicare and Medicaid policy changes including the adoption of prospective payment for Medicare-paid postacute care and Medicaid-paid long-term home and community-based care reforms. This article examines how spending growth in these sectors was affected by state certificate-of-need (CON) laws, which were designed to limit the growth of providers and have remained unchanged for several decades. Compared with states without CON laws, Medicare and Medicaid spending in states with CON laws grew faster for nursing home care and more slowly for home health care. In particular, we observed the slowest growth in community-based care in states with CON for both the nursing home and home health industries. Thus, controlling for other factors, public postacute and long-term care expenditures in CON states have become dominated by nursing homes.
AntelJ. J.OhsfeldtR. L.BeckerE. R. (1995). State-regulation and hospital costs. Review of Economics and Statistics, 77, 416-422. doi:10.2307/2109904
2.
BuntinM. B. (2007). Access to postacute rehabilitation. Archives of Physical Medicine and Rehabilitation, 88, 1488-1493. doi:10.1016/j.apmr.2007.07.023
3.
BurrJ.MutchlerJ.Pilcher-WarrenJ. (2002). Independent living arrangements and state commitment to home and community based services: A multilevel analysis. Gerontologist, 42, 122-122.
4.
CastleN. G.EngbergJ.LaveJ.FisherA. (2009). Factors associated with increasing nursing home closures. Health Services Research, 44, 1088-1109. doi:10.1111/j.1475-6773.2009.00954.x
5.
ChandraA.DaltonM. A.HolmesJ. (2013). Large increases in spending on postacute care in Medicare point to the potential for cost savings in these settings. Health Affairs, 32, 864-872. doi:10.1377/hlthaff.2012.1262
6.
ChenL. W.SheaD. G. (2002). Does prospective payment really contain nursing home costs?Health Services Research, 37, 251-271.
7.
Congressional Research Service. (2007). Medicare’s skilled nursing facility payments. Washington, DC: Domestic Social Policy Division.
8.
ConoverC. J.SloanF. A. (1998). Does removing certificate-of-need regulations lead to a surge in health care spending?Journal of Health Politics, Policy and Law, 23, 455-481.
9.
FederJ.ScanlonW. (1980). Regulating the bed supply in nursing homes. Milbank Memorial Fund Quarterly. Health and Society, 58, 54-88.
10.
FengZ.GrabowskiD. C.IntratorO.ZinnJ.MorV. (2008). Medicaid payment rates, case-mix reimbursement, and nursing home staffing—1996-2004. Medical Care, 46, 33-40. doi:10.1097/MLR.0b013e3181484197
11.
FitzgeraldJ. F.MooreP. S.DittusR. S. (1988). The care of elderly patients with hip fracture. Changes since implementation of the prospective payment system. New England Journal of Medicine, 319, 1392-1397. doi:10.1056/NEJM198811243192106
12.
FreimanM. P.EllisR. P.McGuireT. G. (1989). Provider response to Medicare’s PPS: Reductions in length of stay for psychiatric patients treated in scatter beds. Inquiry, 26, 192-201.
13.
GrabowskiD. C. (2001). Does an increase in the Medicaid reimbursement rate improve nursing home quality?Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 56, S84-S93.
14.
GrabowskiD. C. (2007). Medicare and Medicaid: Conflicting incentives for long-term care. Milbank Quarterly, 85, 579-610. doi:10.1111/j.1468-0009.2007.00502.x
15.
GrabowskiD. C.AfendulisC. C.McGuireT. G. (2011). Medicare prospective payment and the volume and intensity of skilled nursing facility services. Journal of Health Economics, 30, 675-684. doi:10.1016/j.jhealeco.2011.05.014
16.
GrabowskiD. C.FengZ.IntratorO.MorV. (2010). Medicaid bed-hold policy and Medicare skilled nursing facility rehospitalizations. Health Services Research, 45(6 Pt. 2), 1963-1980. doi:10.1111/j.1475-6773.2010.01104.x
17.
GrabowskiD. C.GruberJ. (2007). Moral hazard in nursing home use. Journal of Health Economics, 26, 560-577. doi:10.1016/j.jhealeco.2006.10.003
18.
GrabowskiD. C.OhsfeldtR. L.MorriseyM. A. (2003). The effects of CON repeal on Medicaid nursing home and long-term care expenditures. Inquiry, 40, 146-157.
19.
GrimaldiP. L. (2002). Prospective rates for episodes of home health care. Journal of Health Care Finance, 28(3), 63-75.
20.
HahnE. A.ThomasK. S.HyerK.AndelR.MengH. (2011). Predictors of low-care prevalence in Florida nursing homes: The role of Medicaid waiver programs. Gerontologist, 51, 495-503. doi:10.1093/geront/gnr020
21.
HarringtonC.NgT.LaplanteM.KayeH. S. (2012). Medicaid home- and community-based services: Impact of the Affordable Care Act. Journal of Aging & Social Policy, 24, 169-187. doi:10.1080/08959420.2012.659118
22.
HarringtonC.SwanJ. H.NymanJ. A.CarrilloH. (1997). The effect of certificate of need and moratoria policy on change in nursing home beds in the United States. Medical Care, 35, 574-588. doi:10.1097/00005650-199706000-00004
23.
HuckfeldtP. J.SoodN.EscarceJ. J.GrabowskiD. C.NewhouseJ. P. (2014). Effects of Medicare payment reform: Evidence from the home health interim and prospective payment systems. Journal of Health Economics, 34, 1-18. doi:10.1016/j.jhealeco.2013.11.005
24.
KayeH. S.LaPlanteM. P.HarringtonC. (2009). Do noninstitutional long-term care services reduce Medicaid spending?Health Affairs, 28, 262-272. doi:10.1377/hlthaff.28.1.262
25.
KitchenerM.NgT.MillerN.HarringtonC. (2005). Medicaid home- and community-based services: National program trends. Health Affairs, 24, 206-212. doi:10.1377/hlthaff.24.1.206
26.
LakdawallaD.GoldmanD. P.BhattacharyaJ.HurdM. D.JoyceG. F.PanisC. W. (2003). Forecasting the nursing home population. Medical Care, 41, 8-20. doi:10.1097/01.MLR.0000017785.38545.59
27.
MillerE. A.AllenS. M.MorV. (2009). Commentary: Navigating the labyrinth of long-term care: Shoring up informal caregiving in a home- and community-based world. Journal of Aging & Social Policy, 21, 1-16. doi:10.1080/08959420802473474
28.
MillerN. A.HarringtonC.GoldsteinE. (2002). Access to community-based long-term care: Medicaid’s role. Journal of Aging and Health, 14, 138-159.
29.
MillerN. A.KitchenerM.ElderK. T.KangY.RubinA.HarringtonC. (2005).Variation by disability in state predictors of Medicaid 1915c waiver use and expenditures.Gerontologist, 45, 764-772.
30.
MorV.ZinnJ.AngelelliJ.TenoJ. M.MillerS. C. (2004). Driven to tiers: Socioeconomic and racial disparities in the quality of nursing home care. Milbank Quarterly, 82, 227-256. doi:10.1111/j.0887-378X.2004.00309.x
31.
MuramatsuN.HoyemR. L.YinH. J.CampbellR. T. (2008). Place of death among older Americans: Does state spending on home- and community-based services promote home death?Medical Care, 46, 829-838.
32.
MuramatsuN.YinH.CampbellR. T.HoyemR. L.JacobM. A.RossC. O. (2007). Risk of nursing home admission among older americans: Does states’ spending on home-and community-based services matter?Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 62, S169-S178.
33.
NettenA.DartonR.WilliamsJ. (2003). Nursing home closures: Effects on capacity and reasons for closure. Age and Ageing, 32, 332-337.
34.
NymanJ. A. (1988). Excess-demand, the percentage of Medicaid patients, and the quality of nursing-home care. Journal of Human Resources, 23, 76-92. doi:10.2307/145845
35.
NymanJ. A. (1989). Analysis of nursing-home use and bed supply—Wisconsin, 1983. Health Services Research, 24, 511-537.
36.
NymanJ. A. (1993). Testing for excess demand in nursing home care markets. Medical Care, 31, 680-693.
37.
NymanJ. A. (1994). The effects of market concentration and excess-demand on the price of nursing-home care. Journal of Industrial Economics, 42, 193-204. doi:10.2307/2950490
38.
RivlinA. M.WienerJ. M.HanleyR. J.SpenceD. A. (1988). Who should pay for long-term care for the elderly?Brookings Review, 6(3), 3-9.
39.
RoemerM. I. (1961). Bed supply and hospital utilization: A natural experiment. Hospitals, 35, 36-42.
40.
SagerM. A.EasterlingD. V.KindigD. A.AndersonO. W. (1989). Changes in the location of death after passage of Medicare’s prospective payment system. A national study. New England Journal of Medicine, 320, 433-439. doi:10.1056/NEJM198902163200705
41.
SwanJ.HarringtonC. (1990). Certificate of need and nursing home bed capacity in states. Journal of Health and Social Policy, 2, 87-105.
42.
SwanJ. H.HarringtonC.ClemenaW.PickardR. B.StuderL.deWitS. K. (2000). Medicaid nursing facility reimbursement methods: 1979-1997. Medical Care Research and Review, 57, 361-378.
43.
ThomasK. S.MorV. (2013). The relationship between older Americans Act Title III state expenditures and prevalence of low-care nursing home residents. Health Services Research, 48, 1215-1226. doi:10.1111/1475-6773.12015
44.
WienerJ. M.StevensonD. G.GoldensonS. M. (1999). Controlling the supply of long-term care providers in thirteen states. J Aging & Social Policy, 10(4), 51-72. doi:10.1300/J031v10n04_04
45.
ZinnJ. S. (1994). Market competition and the quality of nursing-home care. Journal of Health Politics, Policy and Law, 19, 555-582. doi:10.1215/03616878-19-3-555
