Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon, USA.
Department of Health Systems Administration, Georgetown University, Washington, District of Columbia, USA.
J Am Geriatr Soc. 2023 Feb;71(2):432-442. doi: 10.1111/jgs.18115. Epub 2022 Nov 5.
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).
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.
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.
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.
为了尊重人们选择就地老化的意愿并控制成本，许多州的医疗补助计划已制定政策，扩大家庭和社区为基础的服务，以替代护理院护理。然而，在全国范围内，特别是在患有阿尔茨海默病和相关痴呆症（ADRD）的双重资格受益人中，对于医疗补助长期服务和支持（LTSS）的使用情况知之甚少。
我们使用了 2016 年来自 30 个州的医疗保险和医疗补助索赔数据，重点关注 65 岁或以上患有 ADRD 的双重资格受益人，并描述了他们在各州使用任何形式的 LTSS 以及 LTSS 的亚型（家庭、社区和护理院服务）的情况。
我们发现，2016 年有 80.5%的患有 ADRD 的双重资格受益人获得了某种形式的医疗补助 LTSS。最常见的 LTSS 场所是护理院（46.7%），其次是家庭（31.5%）和社区（12.2%）。在使用任何形式的 LTSS 的双重资格受益人中，各州之间存在相当大的差异（从缅因州的 61%到蒙大拿州的 96%）。使用的 LTSS 类型也在各州之间差异很大。例如，缅因州、亚利桑那州和南达科他州的家庭服务使用率为 9%，而俄勒冈州为 62%。在大多数州，护理院服务是最常见的 LTSS 类型。然而，在俄勒冈州、阿拉斯加和加利福尼亚州，家庭服务的使用量超过了护理院。
我们的研究结果表明，患有 ADRD 的双重资格受益人在各州之间对 LTSS 的使用情况存在很大差异。考虑到 LTSS 对这一人群及其家庭的重要性，需要更深入地了解州 LTSS 政策以及其他导致 LTSS 使用在各州之间存在广泛差异的因素，以便在各州之间改善 LTSS 的可及性。
