Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb;71(2):432-442.
doi: 10.1111/jgs.18115. Epub 2022 Nov 5.

Use of long-term services and supports among dual-eligible beneficiaries with Alzheimer's disease and related dementias

Hyunjee Kim  1 , Angela Senders  1 , Erika Simeon  1 , Cesar Juarez  1 , Sean Huang  2 , Hiroko Dodge  3 , K John McConnell  1
Affiliations

Use of long-term services and supports among dual-eligible beneficiaries with Alzheimer's disease and related dementias

Hyunjee Kim et al. J Am Geriatr Soc. 2023 Feb.

Abstract

Background: To respect people's preference for aging in place and control costs, many state Medicaid programs have enacted policies to expand home and community-based services as an alternative to nursing facility care. However, little is known about the use of Medicaid long-term services and supports (LTSS) at a national level, particularly among dual-eligible beneficiaries with Alzheimer's disease and related dementias (ADRD).

Methods: Using Medicare and Medicaid claims of 30 states from 2016, we focused on dual-eligible beneficiaries 65 years or older with ADRD and described their use of any form of LTSS and sub-types of LTSS (home-based, community-based, and nursing facility services) across states.

Results: We found that 80.5% of dual-eligible beneficiaries with ADRD received some form of Medicaid LTSS in 2016. The most common LTSS setting was nursing facility (46.7%), followed by home (31.5%) and community (12.2%). There was sizeable state variation in the percentage of dual-eligible beneficiaries with ADRD who used any form of LTSS (ranging from 61% in Maine to 96% in Montana). The type of LTSS used also varied widely across states. For example, home-based service use ranged from 9% in Maine, Arizona, and South Dakota to 62% in Oregon. Nursing facility services were the most common type of LTSS in most states. However, home-based service use exceeded nursing facility use in Oregon, Alaska, and California.

Conclusions: Our findings suggest substantially different use of LTSS across states among dual-eligible beneficiaries with ADRD. Given the importance of LTSS for this population and their families, a deeper understanding of state LTSS policies and other factors that contribute to wide state variation in LTSS use will be necessary to improve access to LTSS across states.

Keywords: dual-eligible beneficiaries; long-term services and supports; people with Alzheimer's disease and related dementias.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest

The authors have no conflicts.

Figures

Figure 1:
Figure 1:
Percentage of dual−eligible beneficiaries at least 65 years of age with Alzheimer’s disease and related dementias (ADRD) who used any long−term services and supports (LTSS) in 2016. SOURCE Authors’ analysis of national Medicare/Medicaid data, 2016. NOTES Percentages are adjusted for age, sex, number of chronic health conditions, and years since first documented ADRD. Black horizontal bars represent 95% confidence intervals.
Figure 2:
Figure 2:
Percentage of dual−eligible beneficiaries at least 65 years of age with Alzheimer’s disease and related dementias (ADRD) who used any home−based services (H), community−based services (C), and/or long−term nursing facility services (N) in 2016. SOURCE Authors’ analysis of national Medicare/Medicaid data, 2016. NOTES Service use is not mutually exclusive, beneficiaries who used more than one type of service were included in each applicable category. Percentages are adjusted for age, sex, number of chronic health conditions, and years since first documented ADRD.
See this image and copyright information in PMC

References

    1. Gorges RJ, Sanghavi P, Konetzka RT. A National Examination Of Long-Term Care Setting, Outcomes, And Disparities Among Elderly Dual Eligibles. Health Affairs. 2019;38(7):1110–1118. doi:10.1377/hlthaff.2018.05409 - DOI - PMC - PubMed
    1. Yan D, Wang S, Temkin-Greener H, Cai S. The Use Patterns of Medicaid Home and Community Based Services Among Medicare/Medicaid Beneficiaries With Dementia. Frontiers in Public Health. 2021;9. Accessed June 15, 2022. 10.3389/fpubh.2021.708402 - DOI - PMC - PubMed
    1. Choi H, Heisler M, Norton EC, Langa KM, Cho TC, Connell CM. Family Care Availability And Implications For Informal And Formal Care Used By Adults With Dementia In The US. Health Affairs. 2021;40(9):1359–1367. doi:10.1377/hlthaff.2021.00280 - DOI - PMC - PubMed
    1. Garfield R, Musumeci M, Reaves EL, Damico A. Medicaid’s Role for People with Dementia. Kaiser Family Foundation; 2015. https://www.kff.org/medicaid/issue-brief/medicaids-role-for-people-with-...
    1. Wang S, Yan D, Temkin-Greener H, Cai S. Nursing home admissions for persons with dementia: Role of home- and community-based services. Health Services Research. 2021;56(6):1168–1178. doi:10.1111/1475-6773.13715 - DOI - PMC - PubMed

Publication types