"Policy determinants of nursing home use in the Pennsylvania Medicaid population, 2013-2019" 

Public Health/Health Policy and Management

Committee:
Howard Degenholtz, HPM (advisor) 
Eric Roberts, HPM
Steven Albert, BCHS
Marc Cohen, Department of Gerontology, McCormack Graduate School, UMass Boston

Abstract: 
This dissertation applies statistical modeling techniques in order to estimate the impact of policy determinants on nursing home use in the Medicaid-covered population in Pennsylvania during the years 2013-2019. Using difference-in-difference analysis, the first essay exploits Pennsylvania’s staggered implementation of mandatory managed care to investigate whether longstay (>100 day) nursing home residents in counties that moved to managed care were more likely to be successfully discharged to a community setting within six months of longstay incidence. The second essay models the association between regional subsidized housing access and discharge to a community setting among longstay nursing facility residents. The third essay uses probabilistic matching to assign HUD program status (public housing, HCV project-based, and Section 202) to a population of waiver-eligible Pennsylvania Medicaid enrollees. Time-to-event analysis is applied in order to compare hazard of nursing home admission among these three housing-defined Medicaid populations.