2019 RDRC Meeting: Incentives for Home- and Community-based Care Under the Affordable Care Act: Implications for Supplemental Security Income Receipt

Published: 2019


One in three 65-year-olds will require long-term care at some point in their lives. Medicaid currently covers these expenses for six out of 10 nursing home residents. Not all those who require care need enough help to justify moving into a nursing home, but in many states Medicaid does not cover care received at home. The Balancing Incentives Program (BIP), a part of the Affordable Care Act, encouraged states that spent most of their Medicaid dollars on nursing home care to adopt programs and practices that extended coverage for care while living at home with relatives, or in assisted-living facilities. In participating states, the BIP may have enabled some elderly to return to home and community settings, or prevented moves into nursing homes. Changes in nursing home residence, in turn, may have changed Supplemental Security Income (SSI) receipt, as nursing home residents are generally not eligible for this form of income support or are eligible for only reduced benefits. Our project uses data from the American Community Survey and the Health and Retirement Study to examine whether and how the BIP changed living arrangements and receipt of SSI. We find declines in the nursing home population, but they begin approximately four years before the BIP and are not likely attributable to it. Nonetheless, we do find the share of elderly receiving SSI rises as the share living in an institutional setting falls. We conclude understanding residency patterns among the elderly may be important for SSI program administration.

Key Findings