title: Do Medicaid wage pass-through payments increase nursing home staffing?
abstract: OBJECTIVE
  To assess the impact of state Medicaid wage pass-through policy on direct-care staffing levels in U.S. nursing homes.
  
  
  METHODS
  Online Survey Certification and Reporting (OSCAR) data, and state Medicaid nursing home reimbursement policies over the period 1996-2004.
  
  
  METHODS
  A fixed-effects panel model with two-step feasible-generalized least squares estimates is used to examine the effect of pass-through adoption on direct-care staff hours per resident day (HPRD) in nursing homes.
  
  
  METHODS
  A panel data file tracking annual OSCAR surveys per facility over the study period is linked with annual information on state Medicaid wage pass-through and related policies.
  
  
  RESULTS
  Among the states introducing wage pass-through over the study period, the policy is associated with between 3.0 and 4.0 percent net increases in certified nurse aide (CNA) HPRD in the years following adoption. No discernable pass-through effect is observed on either registered nurse or licensed practical nurse HPRD.
  
  
  CONCLUSIONS
  State Medicaid wage pass-through programs offer a potentially effective policy tool to boost direct-care CNA staffing in nursing homes, at least in the short term.
authors.affiliation: Center for Gerontology and Health Care Research, Brown University, 121 South Main Street, Providence, RI 02912, USA. zhanlian_feng@brown.edu
authors.forename: Zhanlian
authors.initials: Z
authors.lastname: Feng
authors.forename: Yong Suk
authors.initials: YS
authors.lastname: Lee
authors.forename: Sylvia
authors.initials: S
authors.lastname: Kuo
authors.forename: Orna
authors.initials: O
authors.lastname: Intrator
authors.forename: Andrew
authors.initials: A
authors.lastname: Foster
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
mesh_terms: D000203:Activities of Daily Living; D006302:Health Services Research; D006801:Humans; D016018:Least-Squares Analysis; D008137:Longitudinal Studies; D008484:Medicaid / Q000458:organization & administration*; D015999:Multivariate Analysis; D009728:Nursing Assistants; D009735:Nursing Homes / Q000458:organization & administration*; D009740:Nursing Staff / Q000458:organization & administration*; D009743:Nursing, Practical; D009936:Organizational Innovation; D016134:Organizational Policy; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D012044:Regression Analysis; D012051:Reimbursement Mechanisms / Q000458:organization & administration; D020379:Risk Adjustment; D012456:Salaries and Fringe Benefits / Q000706:statistics & numerical data*; D014481:United States; D016526:Workload
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