Megdalynn Fisher, PhD

Megdalynn Fisher, PhD

she/her

Assistant Professor

Talks and presentations

Local Government Nursing Homes: Incentives, Quality, and Sustainability

March 21, 2026

Presentation, American Society for Public Administration (ASPA) Annual Conference, Los Angeles, California (*expected*)

Medicaid supplemental payments are a vital but often opaque tool in financing long- term care, designed to stabilize providers and ensure access for low-income populations. Yet these payments also create powerful incentives that shape ownership and governance decisions. This paper examines the growing trend of nursing homes converting to local government ownership as a strategy to capture supplemental payments. Using national nursing home data linked to ownership status and quality indicators, I find evidence of a selection effect: facilities with poorer quality (measured by higher rates of on-site inspection deficiencies) are disproportionately those that transition into local government ownership.

Balancing Incentives Meets Medicaid Expansion: Reshaping Long-Term Care Populations

November 15, 2025

Presentation, Association for Public Policy Analysts and Management (APPAM) Annual Conference, Seattle, Washington

The Balancing Incentive Program (BIP) and Medicaid Expansion, both key components of the Affordable Care Act, have significantly reshaped access to long-term services and supports (LTSS) in the United States. Medicaid Expansion increased the number of nursing home (NH) residents \citep{ritter_younger_2022, van_houtven_association_2020}, while BIP offered financial incentives to states to enhance non-institutional LTSS, supporting the use of home and community-based services (HCBS) instead of institutional care. Despite these distinct goals, the combined and independent effects of these policies on nursing home populations remain understudied.

Balancing Incetive Program: Racial, Demographic and Health Sorting Among Nursing Home Residents

November 14, 2025

Presentation, Association for Public Policy Analysts and Management (APPAM) Annual Conference, Seattle, Washington

Policies such as the Balancing Incentive Program (BIP), Managed Long-Term Services and Supports (MLTSS), and Medicaid Expansion have fundamentally reshaped the long-term care landscape in the United States. However, the effects of these policies on racial composition and segregation in nursing homes are not yet well understood. This study evaluates the individual and combined impacts of these policies on the racial demographics of long-stay nursing home residents, with a particular focus on trends in racial segregation, measured by the dissimilarity index. The dissimilarity index quantifies the extent of segregation between two groups, ranging from 0 (complete integration) to 100 (complete segregation), and represents the percentage of individuals from one group who would need to move to achieve an even distribution.

Racial Equity in Long-Term Care: Disentangling the Effects of Managed Long-Term Services and Supports, Medicaid Expansion, and the Balancing Incentive Program

June 25, 2025

Presentation, American Society of Health Economists (ASHEcon) Annual Conference, Nashville, Tennessee

Policies such as the Balancing Incentive Program (BIP), Managed Long-Term Services and Supports (MLTSS), and Medicaid Expansion have fundamentally reshaped the long-term care landscape in the United States. However, the effects of these policies on racial composition and segregation in nursing homes are not yet well understood. This study evaluates the individual and combined impacts of these policies on the racial demographics of long-stay nursing home residents, with a particular focus on trends in racial segregation, measured by the dissimilarity index. The dissimilarity index quantifies the extent of segregation between two groups, ranging from 0 (complete integration) to 100 (complete segregation), and represents the percentage of individuals from one group who would need to move to achieve an even distribution.

Does Public Quality Reporting Improve Quality? The Case of Nursing Home Prescribing of Antipsychotics

November 24, 2024

Poster, Association for Public Policy Analysts and Management (APPAM) Annual Conference, National Harbor, MD

The quality of services provided in nursing homes and other healthcare settings is a high societal concern. Public reporting of provider quality is an important part of the policy making toolkit, to incentivize providers to improve quality, to alleviate information problems in healthcare markets, and enable greater competition.

Racial and Ethnic Segregation in Nursing Homes

September 08, 2023

Presentation, Midwest Health Economics Conference, Chicago, Illinois

In this presentation, we discuss our upcoming contribution to the literature measuring and understanding drivers of racial and ethnic sorting (segregation) in the health care setting by constructing dissimilarity indices (DI) for nursing homes. The dissimilarity index, a commonly used measure in residential segregation studies, ranges from 0 to 1 and in our context describes the share of patients in a health care market who would have to switch homes in order for there to be evenness (no segregation) across the providers in that market. Prior work has computed the DI in healthcare settings but provides limited evidence on how the DI varies across geographic areas and/or is based on data more than a decade old. We combine administrative data on all certified nursing homes in the U.S. with health assessments of long-term stay patients residing in those homes for the years 2011 and 2017. Geographically, we define a nursing home market to be a county.

Public Reporting of Nursing Home Antipsychotic Use: Changes in the Reporting of Exclusionary Diagnoses?

February 17, 2023

Presentation, O'Neill Ph.D. Student Association Annual Student Research Conference, Bloomington, Indiana

Following the public reporting of Antipsychotic Medication (APM) use in nursing homes, we document an increase in prevalence of schizophrenia diagnos, a diagnosis which excludes facilities from the public reporting requirement for these residents. Public reporting is designed to reduce off-label use of APMs, increases in schizophrenia diagnosis are an unintended consequence of the policy that may be attributed to either more accurate diagnosis or upcoding.

Hospital Competition, Quality, and Municipal Debt: Do Non-Profit Hospitals Utilize Municipal Market Credit Access to Fund Competition on Quality

November 18, 2022

Poster, Association for Public Policy Analysts and Management (APPAM) Annual Conference, Washington, D.C.

Using the variation of municipal governments’ credit ratings, I examine associations between Hospital Compare quality ratings, market concentration, and nonprofit hospital municipal market bond issuance to identify the effects of hospital quality measures on bond issuance. Findings include higher bond issuance in counties with lower reported hospital quality.

Tribal Self-Governance and COVID-19 Outcomes

March 15, 2021

Presentation, O’Neill Ph.D. Student Association Annual Conference, Bloomington, Indiana

Does tribal self governance improve COVID-19 outcomes among Native American and Indigenous American populations? I present early findings on collaborative work with Patrick Carlin.

An Advocacy Coalition Framework Approach to Section 340B

February 15, 2020

Presentation, O’Neill Ph.D. Student Association Annual Conference, Bloomington, Indiana

The Section 340B Drug Pricing program is often criticized and defended by various stakeholders. As a program with a nuanced history, growing footprint, poor targeting, and unintended consequences, I explore the program’s development, implementation, and evaluation using an Advocacy Coalition Framework to conceptualize the public policy process.

The Hope of Mankind

April 20, 2017

Oral Recitation, Utah Valley University, Orem, Utah

Fisher, Megdalynn. “The Hope of Mankind,” Oral recitation at the celebration of the inaugural edition of The Journal of Student Leadership, Orem, Utah, April 20, 2017.

Rising Food Prices: The Case of Childhood Poverty in a Developed Economy

April 06, 2017

Presentation, National Confernece on Undergraduate Research, Memphis, TN

Fisher, Megdalynn. “Rising Food Prices: The Case of Childhood Poverty in a Developed Economy.” Oral presentation at the National Conference on Undergraduate Research (NCUR), Memphis, Tennessee, April 6, 2017.