Table 2.
The Effect of Introducing Medicaid Wage Pass-through on Direct-Care Staffing Levels in Nursing Homes in 21 Pass-through Adopter States, 1996–2004
| CNA |
LPN |
RN |
|||||||
|---|---|---|---|---|---|---|---|---|---|
| 2nd Step‡ |
2nd Step‡ |
2nd Step‡ |
|||||||
| 1st Step† (1) OLS | (2) OLS | (3) FGLS | 1st Step† (1) OLS | (2) OLS | (3) FGLS | 1st Step† (1) OLS | (2) OLS | (3) FGLS | |
| Wage pass-through§: | |||||||||
| Year of adoption | 0.0334*** | 0.0288* | 0.0301** | 0.0218 | 0.0254 | 0.0268 | 0.0171 | 0.0208 | 0.0233 |
| (0.0107) | (0.0153) | (0.0126) | (0.0238) | (0.0359) | (0.0319) | (0.0264) | (0.0373) | (0.0373) | |
| 1st year after adoption | 0.0444*** | 0.0428*** | 0.0399*** | 0.0272 | 0.0214 | 0.0226 | 0.0255 | 0.0305 | 0.0297 |
| (0.0144) | (0.0136) | (0.0134) | (0.0179) | (0.0327) | (0.0297) | (0.0322) | (0.0424) | (0.0408) | |
| 2nd/subsequent years | 0.0144 | 0.0149 | 0.0279* | 0.0127 | 0.0629 | 0.0728 | −0.0651 | −0.0134 | −0.0116 |
| (0.0193) | (0.0142) | (0.0141) | (0.0269) | (0.0490) | (0.0436) | (0.0395) | (0.0655) | (0.0623) | |
| Policy repealed | 0.0016 | 0.0163 | 0.0268** | 0.0573* | 0.0463 | 0.0506 | −0.1506** | −0.0864 | −0.0821 |
| (0.0281) | (0.0220) | (0.0125) | (0.0319) | (0.0425) | (0.0329) | (0.0550) | (0.0590) | (0.0566) | |
| Medicaid payment rate | 0.0093 | −0.0025 | −0.0012 | 0.0268 | 0.0469** | 0.0414** | 0.0051 | 0.0023 | 0.0024 |
| (0.0152) | (0.0101) | (0.0079) | (0.0159) | (0.0167) | (0.0167) | (0.0091) | (0.0101) | (0.0093) | |
| Case-mix reimbursement | −0.0442 | −0.0284 | −0.0164 | −0.0341 | −0.0176 | −0.0075 | 0.1118** | 0.1088 | 0.1110* |
| (0.0317) | (0.0207) | (0.0131) | (0.0341) | (0.0371) | (0.0281) | (0.0535) | (0.0712) | (0.0621) | |
| Facility fixed effects | Yes | Yes | Yes | ||||||
| State fixed effects | Yes | Yes | Yes | ||||||
| Year fixed effects | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Cluster (state) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Number of observations | 30,377 | 189 | 189 | 30,473 | 189 | 189 | 30,548 | 189 | 189 |
In all first-step OLS models, the following time-varying covariates are controlled for—at the facility level: acuity index, employment of a nurse practitioner or physician assistant, having an Alzheimer's unit, and percent Medicaid; at the county level: average number of empty beds per nursing home, number of RNs per hospital bed, number of LPNs per hospital bed, number of nursing home beds per 1,000 population 65+, Medicare-managed care penetration rate, and wage index.
In all second-step models, variables are ρ-differenced after being demeaned.
Reference category=preadoption.
Statistical significance:
p<.10.
p<.05.
p<.01.
Numbers in parentheses are robust standard errors.