CAMRI: Extended Nursing Facility Stays Among California’s Dual Eligible and Medi-Cal-Only Beneficiaries


This report describes nursing home stays of two of California’s most vulnerable populations: those who are dually eligible for Medicare and Medi-Cal and Medi-Cal only beneficiaries. Findings suggest the need for improved coordination between health care and long-term services and supports systems in order to more efficiently and effectively provide services to meet people’s needs.

Date Updated: 09/18/2013

Medicaid is the single largest payer of nursing facility (NF) care (also referred to as nursing home care) in the United States, accounting for 31% ($46.1 billion) of the total $149.3 billion spent nationally on this care in 2011. Medi-Cal alone, California‟s Medicaid program, spent nearly $3 billion on NF care in 2008 for eligible beneficiaries in fee-for-service (FFS) who were age 18 and above.

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This is the third report coming from the California Medicaid Research Institute (CAMRI) project entitled: Comprehensive Analysis of Home- and Community-Based Services in California. The report describes Medicare and Medi-Cal spending for those beneficiaries using long-term services and supports funded by Medi-Cal.

The California Medicaid Research Institute (CAMRI) developed an integrated and longitudinal database containing Medi-Cal and Medicare claims and assessment data of LTSS recipients in California in 2008. CAMRI’s integrated database provides a unique opportunity to look at characteristics and program spending across the entire care continuum for beneficiaries with LTSS needs within Medi-Cal and for dual eligibles across Medicare and Medi-Cal. This report focuses on LTSS use and spending in the eight duals demonstration counties.

On March 27, 2013, the State of California and the Centers for Medicare and Medicaid Services (CMS) formalized a Memorandum of Understanding (MOU) to establish a Federal-State partnership to implement the Dual Eligibles Integration Demonstration, also referred to as Cal MediConnect. This Fact Sheet provides background information about Cal MediConnect and summarizes the key points of the MOU.