Medicaid incentive reimbursement programs in long-term care: An evaluation of the Florida Medicaid AIDS nursing home admission program

This study evaluated the Florida Medicaid Acquired Immunodeficiency Syndrome (AIDS) nursing home admission incentive program using goal attainment and constituency satisfaction criteria. The program provides additional reimbursement to nursing homes which admit Medicaid-covered persons with AIDS (PWAs). Goal attainment, i.e., increasing the rate of PWA admissions, was assessed using ICD-9-CM coded (for AIDS) Medicaid-covered hospital discharges to nursing homes as a surrogate nursing home admission measure. To assess satisfaction, both program constituencies--hospitals (N = 120) which place and nursing homes (N = 308) which agree to admit PWAs--were surveyed in 10 counties. For both constituencies, the surveys were designed to measure satisfaction along two dimensions: (1) the degree of satisfaction with the Florida program, and (2) the level of agreement with the general concept of incentive reimbursement. For nursing homes, the survey also measured: institutional characteristics, financial characteristics, and medical and technological issues. The goal attainment results revealed that the PWA admission rate showed no meaningful change over the five years studied. The constituency satisfaction results revealed that both constituencies were moderately satisfied with the Florida program and incentive programs generally, but that such satisfaction was not related to the number of PWAs admitted to nursing homes. Nursing home institutional characteristics and medical issues were not related to the number of PWAs admitted, but financial characteristics and technological issues were significantly (but negatively) related. The following policy implications were drawn. Although the Florida program did not meet its goal, both constituencies were satisfied with the program and incentives generally, leaving open the possibility for program modification. The previously unconfirmed concern that nursing homes fear intergenerational problems if PWAs were to be admitted was supported by the findings, but nursing home assertions that their lack of appropriate technology restricts PWA admissions were not.