Balancing Incetive Program: Racial, Demographic and Health Sorting Among Nursing Home Residents

• In Event: Race, Gender and Governance

Abstract

Policies such as the Balancing Incentive Program (BIP), Managed Long-Term Services and Supports (MLTSS), and Medicaid Expansion have fundamentally reshaped the long-term care landscape in the United States. However, the effects of these policies on racial composition and segregation in nursing homes are not yet well understood. This study evaluates the individual and combined impacts of these policies on the racial demographics of long-stay nursing home residents, with a particular focus on trends in racial segregation, measured by the dissimilarity index. The dissimilarity index quantifies the extent of segregation between two groups, ranging from 0 (complete integration) to 100 (complete segregation), and represents the percentage of individuals from one group who would need to move to achieve an even distribution.Using longitudinal data and leveraging state-level policy variation, we estimate changes in the distribution of Black, Hispanic, and white long-stay nursing home residents and explore how these shifts intersect with other demographic and health factors. Our results show that participation in MLTSS reduces estimates of segregation (measured by the dissimilarity index) among Black long-stay residents at the county level by 1.8 (95% CI: 1.3 to 2.2) index points, a meaningful change given that county-level segregation indices often range between 20 and 40 in nursing home markets. These reductions were observed while controlling for other community characteristics, including Medicaid reliance, resident age, variance in nursing home quality ratings, unemployment rates, political ideology, and the county’s social vulnerability index.Recognizing the importance of intersectionality, this study highlights the compounded nature of disparities shaped by race, health, and social identities in long-term care settings. By linking state policy initiatives to measurable changes in racial integration, we underscore how policy design can mitigate structural inequities in nursing home care—or inadvertently exacerbate them. Our findings contribute to understanding how policy interventions can advance—or hinder—equity in nursing home care, offering critical insights for future reforms aimed at fostering a more inclusive long-term care system.

Author

• Megdalynn Fisher, Florida International University
  Presenting Author