IDEAS home Printed from https://ideas.repec.org/p/ehl/lserod/127078.html

Long-term care partnership effects on Medicaid and private insurance

Author

Listed:
  • Costa-Font, Joan
  • Raut, Nilesh

Abstract

We examine the impact of the Long-Term Care Insurance Partnership (LTCIP) program—a collaborative initiative between the state-level Medicaid programs and private health insurance companies designed to promote private long-term care insurance (LTCI)—on insurance ownership and Medicaid utilization. We draw on individual-level longitudinal data and employ a difference-in-differences (DD) design adjusted for the staggered implementation of the program between 2005 and 2018. Our results suggest that the rollout of the LTCIP program led to a 1.54 percentage point (pp) (14.7%) increase in LTCI ownership and a 0.82 pp (13.3%) reduction in Medicaid uptake. Our estimates suggest that these combined effects led to an approximate average cost saving of $74 per 65-year-old participant. These findings are explained by a certain degree of substitution between LTCIP and traditional LTCI contracts, ultimately postponing the use of Medicaid benefits.

Suggested Citation

  • Costa-Font, Joan & Raut, Nilesh, 2025. "Long-term care partnership effects on Medicaid and private insurance," LSE Research Online Documents on Economics 127078, London School of Economics and Political Science, LSE Library.
    • Handle: RePEc:ehl:lserod:127078
    as

    Download full text from publisher

    File URL: https://researchonline.lse.ac.uk/id/eprint/127078/
    File Function: Open access version.
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Victor R. Fuchs, 2018. "The New Demographic Transition: Most Gains in Life Expectancy Now Realized Late in Life," World Scientific Book Chapters, in: Health Economics and Policy Selected Writings by Victor Fuchs, chapter 32, pages 379-401, World Scientific Publishing Co. Pte. Ltd..
    2. Goda, Gopi Shah & Golberstein, Ezra & Grabowski, David C., 2011. "Income and the utilization of long-term care services: Evidence from the Social Security benefit notch," Journal of Health Economics, Elsevier, vol. 30(4), pages 719-729, July.
    3. Clément de Chaisemartin & Xavier D'Haultfœuille, 2020. "Two-Way Fixed Effects Estimators with Heterogeneous Treatment Effects," American Economic Review, American Economic Association, vol. 110(9), pages 2964-2996, September.
    4. Goda, Gopi Shah, 2011. "The impact of state tax subsidies for private long-term care insurance on coverage and Medicaid expenditures," Journal of Public Economics, Elsevier, vol. 95(7-8), pages 744-757, August.
    5. Damian Clarke & Kathya Tapia-Schythe, 2021. "Implementing the panel event study," Stata Journal, StataCorp LLC, vol. 21(4), pages 853-884, December.
    6. Manasi Deshpande & Yue Li, 2019. "Who Is Screened Out? Application Costs and the Targeting of Disability Programs," American Economic Journal: Economic Policy, American Economic Association, vol. 11(4), pages 213-248, November.
    7. Courtemanche, Charles & He, Daifeng, 2009. "Tax incentives and the decision to purchase long-term care insurance," Journal of Public Economics, Elsevier, vol. 93(1-2), pages 296-310, February.
    8. Nichols, Albert L & Zeckhauser, Richard J, 1982. "Targeting Transfers through Restrictions on Recipients," American Economic Review, American Economic Association, vol. 72(2), pages 372-377, May.
    9. Ai, Chunrong & Norton, Edward C., 2003. "Interaction terms in logit and probit models," Economics Letters, Elsevier, vol. 80(1), pages 123-129, July.
    10. Zeckhauser, Richard, 2021. "Strategic sorting: the role of ordeals in health care," Economics and Philosophy, Cambridge University Press, vol. 37(1), pages 64-81, March.
    11. Congressional Budget Office, 2013. "Rising Demand for Long-Term Services and Supports for Elderly People," Reports 44363, Congressional Budget Office.
    12. Susan Athey & Guido W. Imbens, 2006. "Identification and Inference in Nonlinear Difference-in-Differences Models," Econometrica, Econometric Society, vol. 74(2), pages 431-497, March.
    13. Congressional Budget Office, 2013. "Rising Demand for Long-Term Services and Supports for Elderly People," Reports 44363, Congressional Budget Office.
    14. Jeffrey R. Brown & Amy Finkelstein, 2008. "The Interaction of Public and Private Insurance: Medicaid and the Long-Term Care Insurance Market," American Economic Review, American Economic Association, vol. 98(3), pages 1083-1102, June.
    15. Amy Finkelstein & Kathleen McGarry, 2006. "Multiple Dimensions of Private Information: Evidence from the Long-Term Care Insurance Market," American Economic Review, American Economic Association, vol. 96(4), pages 938-958, September.
    16. Sun, Liyang & Abraham, Sarah, 2021. "Estimating dynamic treatment effects in event studies with heterogeneous treatment effects," Journal of Econometrics, Elsevier, vol. 225(2), pages 175-199.
    17. Callaway, Brantly & Sant’Anna, Pedro H.C., 2021. "Difference-in-Differences with multiple time periods," Journal of Econometrics, Elsevier, vol. 225(2), pages 200-230.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Joan Costa‐Font & Nilesh Raut, 2025. "Long‐Term Care Partnership Effects on Medicaid and Private Insurance," Health Economics, John Wiley & Sons, Ltd., vol. 34(6), pages 1171-1187, June.
    2. Brown, Jessica H., 2023. "The impact of a long-term care information campaign on insurance coverage," Journal of Health Economics, Elsevier, vol. 92(C).
    3. Yadav, Anil & McHale, John & Harold, Jason & O'Neill, Stephen, 2024. "Estimating effects of staggered intervention with count and binary outcomes: a simulation study," Research Technical Papers 4/RT/24, Central Bank of Ireland.
    4. Jing Dong & Fabrice Smieliauskas & R. Tamara Konetzka, 2019. "Effects of long-term care insurance on financial well-being," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 44(2), pages 277-302, April.
    5. Jeffrey M Wooldridge, 2023. "Simple approaches to nonlinear difference-in-differences with panel data," The Econometrics Journal, Royal Economic Society, vol. 26(3), pages 31-66.
    6. Goodman-Bacon, Andrew, 2021. "Difference-in-differences with variation in treatment timing," Journal of Econometrics, Elsevier, vol. 225(2), pages 254-277.
    7. R. Tamara Konetzka & Daifeng He & Jing Dong & John A. Nyman, 2019. "Moral hazard and long-term care insurance," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 44(2), pages 231-251, April.
    8. Wang, Qianqian & Sun, Xinmeng & Xiong, Haoyang & Wang, Qi & Zhang, Bing, 2024. "Environmental taxes, environmental outsourcing, and pollution abatement: Evidence from Chinese industrial sewage discharge enterprises," Energy Economics, Elsevier, vol. 133(C).
    9. Bas Scheer & Wiljan van den Berge & Maarten Goos & Alan Manning & Anna Salomons, 2022. "Alternative Work Arrangements and Worker Outcomes: Evidence from Payrolling," CPB Discussion Paper 435, CPB Netherlands Bureau for Economic Policy Analysis.
    10. M. Martin Boyer & Philippe De Donder & Claude Denys Fluet & Marie-Louise Leroux & Pierre-Carl Michaud, 2018. "A Canadian Parlor Room-Type Approach to the Long-Term Care Insurance Puzzle," CIRANO Working Papers 2018s-13, CIRANO.
    11. Cocco, Valentin & Chakir, Raja & Mouysset, Lauriane, 2025. "Guilty or scapegoat? Land consolidation and hedgerow decline," Journal of Environmental Economics and Management, Elsevier, vol. 133(C).
    12. Rik Chakraborti & Gavin Roberts, 2023. "How price-gouging regulation undermined COVID-19 mitigation: county-level evidence of unintended consequences," Public Choice, Springer, vol. 196(1), pages 51-83, July.
    13. Sergi Jiménez‐Martín & José M. Labeaga‐Azcona & Cristina Vilaplana‐Prieto, 2016. "Interactions between Private Health and Long‐term Care Insurance and the Effects of the Crisis: Evidence for Spain," Health Economics, John Wiley & Sons, Ltd., vol. 25(S2), pages 159-179, November.
    14. Brehm, Johannes & Pestel, Nico & Schaffner, Sandra & Schmitz, Laura, 2025. "From Low Emission Zone to academic track: Environmental policy effects on educational achievement in elementary school," Journal of Environmental Economics and Management, Elsevier, vol. 132(C).
    15. Mark Kattenberg & Bas Scheer & Jurre Thiel, 2023. "Causal forests with fixed effects for treatment effect heterogeneity in difference-in-differences," CPB Discussion Paper 452, CPB Netherlands Bureau for Economic Policy Analysis.
    16. Li, Pei & Liu, Kaihao & Lu, Yi & Peng, Lu, 2025. "Organizing regulatory structure and local air quality: Evidence from the environmental vertical management reform in China," Journal of Comparative Economics, Elsevier, vol. 53(1), pages 139-164.
    17. Chen, Jidong & Shi, Xinzheng & Zhang, Ming-ang & Zhang, Sihan, 2024. "Centralization of environmental administration and air pollution: Evidence from China," Journal of Environmental Economics and Management, Elsevier, vol. 126(C).
    18. Alexander Cuntz & Alessio Muscarnera & Utsav Bahl & Prince C. Oguguo, 2024. "Are the best tunes played on the oldest fiddles? Distribution and digitization of recorded classical music," WIPO Economic Research Working Papers 87, World Intellectual Property Organization - Economics and Statistics Division.
    19. Martin Boyer & Philippe De Donder & Claude Fluet & Marie-Louise Leroux & Pierre-Carl Michaud, 2017. "Long-Term Care Insurance: Knowledge Barriers, Risk Perception and Adverse Selection," NBER Working Papers 23918, National Bureau of Economic Research, Inc.
    20. Elizabeth Webster & Alfons Palangkaraya & Paul H. Jensen & Russell Thomson, 2024. "The effects of university-industry collaboration subsidies on firm performance," Melbourne Institute Working Paper Series wp2024n14, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;

    JEL classification:

    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • H11 - Public Economics - - Structure and Scope of Government - - - Structure and Scope of Government
    • H24 - Public Economics - - Taxation, Subsidies, and Revenue - - - Personal Income and Other Nonbusiness Taxes and Subsidies

    NEP fields

    This paper has been announced in the following NEP Reports:

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:ehl:lserod:127078. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: LSERO Manager (email available below). General contact details of provider: https://edirc.repec.org/data/lsepsuk.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.