Asset Spend-Down and Medicaid Enrollment in Nursing Homes

What is the rate of Medicaid “spend-down” among nursing home residents enrolled in traditional Medicare?In this cohort study of 191 416 US nursing home residents, 16.4% of residents who were initially not enrolled in Medicaid (largely self-pay) who entered a nursing home in 2018 spent down their assets and became enrolled in Medicaid between 2018 and 2022. The likelihood of spending down assets and enrolling in Medicaid varied by demographic characteristics and time spent in a nursing home.This study suggests that Medicaid spend-down has implications for individuals’ and families’ financial well-being and likely the long-term financial sustainability of the Medicaid program.

Corresponding Author: Gabriella Aboulafia, MPP, PhD Program in Health Policy, Harvard University, Eight Story St, Cambridge, MA 02138 (gaboulafia@g.harvard.edu).

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