The Effect of Medicaid Managed Long-Term Services and Supports Spending on Nursing Home Care Quality in the United States

The number of US states operating Medicaid managed long-term services and supports (MLTSS) programs grew from 8 to 24 between 2004 and 2019, driven by the challenges of an aging population. Significant heterogeneity exists across states in program features, structure, and spending. This study examined whether spending dimensions, specifically capitation rates and market coverage rates (the proportion of Medicaid nursing home expenditures distributed through managed care), influence the quality of care in nursing homes within MLTSS states.