Abstract
Relationship Between Medicaid Home- and Community-Based Services and Nursing Home Entry Among People Living With Dementia
Karen Shen, PhD, Assistant Professor, Johns Hopkins University Bloomberg School of Public Health
In recent decades, state Medicaid programs have dramatically increased investment in home- and community-based services (HCBS) for older adults and people with disabilities. HCBS have great potential to defray costs by delaying or preventing nursing home entry, which may be particularly important for people with ADRD, who often require substantial care that may overwhelm family caregivers Yet, access to critical HCBS for those living with ADRD is limited: only 25% of people with ADRD are “dual-eligible” (i.e. eligible for Medicaid in addition to Medicare) due to Medicaid’s strict income and asset requirements5 and there is broad cross-state variation in the generosity of HCBS coverage within Medicaid. The extent to which HCBS services reach populations at high risk of nursing home placement and the types of HCBS services used by such patients are unknown. Moreover, causal evidence of the impact of HCBS on nursing home entry and public spending is urgently needed to inform policymaking. This pilot will use detailed, assessment-level data from the universe of nursing home residents, linked to Medicaid claims data, in order to:
Compare the degree of functional and cognitive impairment at admission of dual-eligible PLWD who moved to a nursing home and used HCBS in the six months preceding their admission, vs. those who did not use HCBS in the six months prior to their admission, across different types of HCBS. Hypothesis: PLWD who entered nursing homes with preceding HCBS use will have greater cognitive and physical impairment than PLWD entering without preceding HCBS use.
Determine the causal relationship between state-level HCBS generosity and the likelihood that PLWD experience lower-need nursing home entry. Hypothesis: More generous HCBS benefits lower the probability of lower-need nursing home entry among dual-eligible people with ADRD, but not among low-income people with ADRD who are ineligible for Medicaid benefits.