Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Am Med Dir Assoc. 2024 Apr;25(4):722-728. doi: 10.1016/j.jamda.2023.11.004. Epub 2023 Dec 13.
Nearly half of all state Medicaid agencies in the United States have implemented managed long-term services and supports (MLTSS). Data gaps have inhibited our understanding of MLTSS experiences to date. We draw on a national survey with novel data linkages to develop a profile of older dual-enrollees with significant LTSS needs by MLTSS program presence.
Cross-sectional observational study using the 2015 round of the National Health and Aging Trends Study (NHATS), a longitudinal study of a nationally representative sample of Medicare beneficiaries aged 65 years and older.
The sample comprised 275 participants who self-reported Medicaid enrollment and met our definition of significant LTSS need as defined by receiving help with 2 or more self-care or mobility activities (eating, bathing, toileting, dressing, bed transfer, indoor mobility).
Bivariate analyses were used to comparatively examine differences in demographic, health, and care circumstances by MLTSS, as defined by living in a county with MLTSS program presence.
Among approximately 1 million (weighted sample) older dual-enrollees with significant LTSS needs, 56.2% (weighted percentage) lived in counties with MLTSS and 43.7% lived in counties with mandatory MLTSS enrollment in 2015. Those living in areas with MLTSS were much more likely to be of Hispanic or other race and ethnicity (50.5% vs 15.1%, P < .001) yet less likely to live in a rural location (8.7% vs 31.4%, P < .05) or in a residential care facility or nursing home (18.4% vs 34.7%, P < .05). The majority (78.5%) received assistance from 2 or more helpers and received more than 70 hours of care per week.
Our findings reinforce the growing reach of MLTSS programs and importance of filling evidence gaps about who these programs are serving.
美国近一半的州医疗补助机构已经实施了长期服务和支持管理（MLTSS）。数据空白限制了我们对 MLTSS 经验的理解。我们利用一项具有新颖数据链接的全国性调查，根据 MLTSS 计划的存在情况，为有重大长期服务需求的老年双重参保者建立一个概况。
使用 2015 年全国健康老龄化趋势研究（NHATS）的一轮横断面观察研究，这是一项对 65 岁及以上医疗保险受益人的全国代表性样本进行的纵向研究。
该样本由 275 名自我报告参加医疗补助的参与者组成，他们符合我们对有重大长期服务需求的定义，即需要帮助完成 2 项或更多自我护理或移动活动（进食、洗澡、上厕所、穿衣、床转移、室内移动）。
使用双变量分析比较 MLTSS（根据居住在有 MLTSS 计划存在的县来定义）存在情况下，人口统计学、健康和护理情况的差异。
在大约 100 万（加权样本）有重大长期服务需求的老年双重参保者中，56.2%（加权百分比）居住在有 MLTSS 的县，43.7%居住在 2015 年有强制性 MLTSS 参保的县。那些居住在有 MLTSS 的地区的人更有可能是西班牙裔或其他种族和民族（50.5%比 15.1%，P<.001），而不太可能居住在农村地区（8.7%比 31.4%，P<.05）或居住在护理院或疗养院（18.4%比 34.7%，P<.05）。大多数人（78.5%）得到了 2 个或更多帮手的帮助，每周接受的护理时间超过 70 小时。
我们的研究结果加强了 MLTSS 计划的不断扩大，并强调了填补关于这些计划服务对象的证据空白的重要性。
