States differ widely in the use of long-term services and supports for people with dementia, according to a new study of dually eligible Medicare and Medicaid beneficiaries.
The study examined Medicare and Medicaid claims across 30 states in 2016. Study participants included dual-eligible beneficiaries aged 65 years and older with Alzheimer’s and related dementias. Investigators tracked the use of any form of LTSS, including home-based, community-based and nursing facility services.
Most (80%) of participants received Medicaid LTSS in 2016, they found. Overall, beneficiaries were most likely to receive LTSS in a nursing facility (47%). About 31% of services were available in the home, and 12% of beneficiaries received services in the community.
Improving LTSS access
Some state differences were stark. The use of any form of LTSS for dual-eligible beneficiaries with dementia ranged from 61% in Maine to 96% in Montana. Home-based service use ranged from 9% in Maine, Arizona and South Dakota, to 62% in Oregon, for example. And although nursing facilities topped the LTSS list of service type in most states, home-based services had greater utilization in not only Oregon, but in Alaska and California as well, the researchers found.
Many states have sought to expand home- and community-based services in an attempt to honor older adults’ preferences and control costs,. But until now, LTSS Medicaid services at a national level have not been studied extensively, especially among dually eligible recipients with dementia, the authors noted. The study results show that improving access to LTSS across states will require a better understanding of state LTSS policies and other factors that contribute to variations in use, they concluded.
Full findings were published in the Journal of the American Geriatrics Society.
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