{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T14:35:06Z","timestamp":1777732506023,"version":"3.51.4"},"reference-count":46,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2018,1,1]],"date-time":"2018-01-01T00:00:00Z","timestamp":1514764800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100005001","name":"California Department of Health Care Services","doi-asserted-by":"crossref","award":["#07-65682-A02"],"award-info":[{"award-number":["#07-65682-A02"]}],"id":[{"id":"10.13039\/100005001","id-type":"DOI","asserted-by":"crossref"}]},{"name":"NIH National Research Service Award","award":["#T32HP19025"],"award-info":[{"award-number":["#T32HP19025"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["INQUIRY"],"published-print":{"date-parts":[[2018,1,1]]},"abstract":"<jats:p>Nearly one-third of adult Medicaid beneficiaries who receive long-term services and supports (LTSS) consist of older adults and persons with disabilities who are not eligible for Medicare. Beneficiaries, advocates, and policymakers have all sought to shift LTSS to home and community settings as an alternative to institutional care. We conducted a retrospective cohort study of Medicaid-only adults in California with new use of LTSS in 2006-2007 (N = 31 849) to identify unique predictors of entering nursing facilities versus receiving Medicaid home and community-based services (HCBS). Among new users, 18.3% entered into nursing facilities, whereas 81.7% initiated HCBS. In addition to chronic conditions, functional and cognitive limitations, substance abuse disorders (odds ratio [OR] 1.35; 95% confidence interval [CI]: 1.23, 1.48), and homelessness (OR: 4.35, 9% CI: 3.72, 5.08) were associated with higher odds of nursing facility entry. For older adults and persons with disabilities covered by Medicaid only, integration with housing and behavioral health services may be key to enabling beneficiaries to receive LTSS in noninstitutional settings.<\/jats:p>","DOI":"10.1177\/0046958018768316","type":"journal-article","created":{"date-parts":[[2018,4,10]],"date-time":"2018-04-10T08:48:55Z","timestamp":1523350135000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Predictors of Nursing Facility Entry by Medicaid-Only Older Adults and Persons With Disabilities in California"],"prefix":"10.1177","volume":"55","author":[{"given":"Michelle","family":"Ko","sequence":"first","affiliation":[{"name":"University of California, Davis, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert J.","family":"Newcomer","sequence":"additional","affiliation":[{"name":"University of California, San Francisco, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlene","family":"Harrington","sequence":"additional","affiliation":[{"name":"University of California, San Francisco, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denis","family":"Hulett","sequence":"additional","affiliation":[{"name":"University of California, San Francisco, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taewoon","family":"Kang","sequence":"additional","affiliation":[{"name":"University of California, San Francisco, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew B.","family":"Bindman","sequence":"additional","affiliation":[{"name":"University of California, San Francisco, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2018,4,10]]},"reference":[{"key":"bibr1-0046958018768316","volume-title":"MACStats: Medicaid and CHIP Data Book","author":"Medicaid and CHIP Payment and Access Commission","year":"2015"},{"key":"bibr2-0046958018768316","unstructured":"Musumeci M. Measuring Long-Term Services and Supports Rebalancing. http:\/\/kff.org\/medicaid\/fact-sheet\/measuring-long-term-services-and-supports-rebalancing\/. Published 2015. Accessed September 13, 2016."},{"key":"bibr3-0046958018768316","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2318-7-13"},{"key":"bibr4-0046958018768316","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2016.08.017"},{"key":"bibr5-0046958018768316","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000491"},{"key":"bibr6-0046958018768316","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000379"},{"key":"bibr7-0046958018768316","doi-asserted-by":"publisher","DOI":"10.1080\/08959420.2013.766069"},{"key":"bibr8-0046958018768316","volume-title":"Medicaid\u2019s Role in Providing Assistance With Long-Term Services and Supports","author":"Medicaid and CHIP Payment and Access Commission","year":"2014"},{"issue":"2","key":"bibr9-0046958018768316","first-page":"39","volume":"20","author":"Liu K","year":"1998","journal-title":"Health Care Financ Rev"},{"key":"bibr10-0046958018768316","volume-title":"The Faces of Medicaid III: Refining the Portrait of People with 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Remarks by Administrator Seema Verma at the National Association of Medicaid Directors (NAMD) 2017 Fall Conference","year":"2017"},{"key":"bibr30-0046958018768316","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2013.377"},{"key":"bibr31-0046958018768316","doi-asserted-by":"publisher","DOI":"10.1080\/1533256X.2012.646630"},{"key":"bibr32-0046958018768316","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2013.3575"},{"key":"bibr33-0046958018768316","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.1630"},{"key":"bibr34-0046958018768316","volume-title":"Promising Practices to Integrate Physical and Mental Health Care for Medi-Cal Members","author":"Hamblin A","year":"2016"},{"key":"bibr35-0046958018768316","volume-title":"Integrating Behavioral Health Into Medicaid Managed Care: Design and Implementation Lessons From State Innovators","author":"Soper MH.","year":"2016"},{"key":"bibr36-0046958018768316","volume-title":"Integrating Physical and Behavioral 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