All ETDs from UAB

Advisory Committee Chair

Allyson G Hall

Advisory Committee Members

Amy Y Landry

Robert Weech-Maldonado

Bisakha Sen

Document Type


Date of Award


Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions


The growing number of people over the age of 65 in the U.S. will exacerbate already inadequate resources for long-term care, producing increased public health costs. The Long-Term Care Partnership Program (LTCPP) was proposed to save Medicaid expenditures by incentivizing the purchase of long-term care insurance. At this juncture, it is unclear if the partnership program saves the government money. This study draws from the expected utility theory and resource dependency theory to determine whether the LTCPP has increased the purchase of private long-term care insurance and reduced Medicaid expenditures in nursing homes in states that have adopted the partnership program. In Aim 1, a fixed-effects model examined within-state differences in enrollment in private LTCI, as shown by the number of covered lives from 2006-2016. The National Association of Insurance Commissioners Experience Reports were used from 2006-2016 to quantify the increase in number of covered lives. In Aim 2, a fixed-effects model examined within-state differences in Medicaid as a percentage of the payment to nursing homes from 2000-2016. The LTC Focus Data from Brown University was analyzed at the state level to quantify the delta within each state for the percentage of nursing home payment from Medicaid due to the presence of the LTCPP. The results from aim 1 reveal a statistically significant relationship between the number of years since the LTCPP had been adopted in a state and the number of lives covered by LTCI (p<0.05). The study demonstrates that for every year a state has adopted the LTCPP, an additional 1,850 people are covered by LTCI. In aim 2, the results indicate that for every additional year that a state has adopted the LTCPP, there is an increase in the proportion of residents whose primary support is from Medicaid (p <0.05). While the increase is small, 0.20%, it effectively portrays that the LTCPP is not operative in saving government dollars in nursing homes. Overall, the findings from the study demonstrate that while the LTCPP does incentivize additional purchases of LTCI, this does not result in a reduction in Medicaid expenditures in nursing homes.



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