Tuesday, April 23, 2024
4/23/2024
Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) are irreversible neurocognitive disorders characterized by progressive decline in memory, cognition, and the ability to live independently. The public health burden of care for individuals with AD/ADRD is enormous, with national costs exceeding $277 billion in 2018, including $186 billion paid by Medicare and Medicaid. Despite such investments, coverage of home and community-based services (HCBS) is often inadequate to meet the needs of community-dwelling individuals with AD/ADRD. HCBS (e.g., home health care, personal care services) are likely to be costly than institutional care, more consistent with patient wishes, and may result in better outcomes. Greater access to HCBS may delay or replace the need for nursing home care, thus increasing the level of cognitive and functional impairment that necessitates admission to a nursing home. Many state Medicaid programs have begun to implement policies that incentivize a shift from institutional care to lower-cost HCBS. However, the impact of financial incentives on setting of care (home versus institution) for older adults with AD/ADRD is not well understood. The proposed study takes advantage of a natural experiment in New York state. Between 2012 and 2015, New York transitioned from fee-for-service delivery of HCBS to a managed long term care (MLTC) model that shifted the responsibility for costs to managed care plans. All Medicaid beneficiaries requiring more than 120 days of long term care were required to enroll in MLTC. The mandate was implemented in phases, starting in New York City and gradually expanding to other areas of the state. This natural experiment creates a unique opportunity to study the impact of financial incentives on setting of care (home versus institution) for older adults with AD/ADRD. Older adults (aged 65+) who are dually eligible for Medicare and Medicaid are affected by these incentives. Our team will leverage multiple longitudinal data sources to accomplish the following aims: 1) Describe trends in coverage and utilization of long term care services among older adults in New York state diagnosed with AD/ADRD between 2010 and 2019; 2) Evaluate changes in the intensity of home health care and nursing home care (days per year) among dual eligible older adults with AD/ADRD following implementation of MLTC mandates; 3) Evaluate changes in cognitive function and functional status (ability to perform activities of daily living) among dual eligible older adults with AD/ADRD admitted to home health care or nursing home following implementation of MLTC mandates. The goal of this new investigator-initiated R21 is to provide policymakers and other stakeholders with rigorous analyses to inform the design of financial incentives to improve delivery of long term care services for older adults with AD/ADRD. Findings will inform development of an R01 to study the impact of financial incentives on long term care utilization and outcomes among older adults with AD/ADRD across multiple states.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).
