Service Utilization and Consumer-Reported Unmet Needs in Medicaid Home- and Community-Based Services for Older Adults.

Home- and community-based services (HCBS) are increasingly favored over nursing home care by older consumers and by policymakers. Consumer-reported unmet service needs in HCBS are important service quality and person-centeredness indicators. Yet, we know little about consumer-reported unmet needs among HCBS users. Therefore, we evaluated consumer-reported unmet needs (i.e. that the services they receive currently were not meeting their needs and goals) for 9,693 Medicaid HCBS beneficiaries (age ≥65 years) in the National Core Indicators-Aging and Disability survey (2016-2019). Personal care (59.7%) and homemaker (24.4%) services were the most utilized HCBS. Prevalence of unmet needs was highest in transportation (12.2%) and homemaker (11.7%) services. Consumers with poorer self-rated health, dementia, or mental illness; ndividuals living alone; and people of color were more likely to report unmet needs in HCBS such as personal care, caregiver support, adult day, or transportation. Proxy survey respondents were more likely to report unmet needs in caregiver support and personal care services and less likely to report unmet needs in transportation services. Consumer-reported unmet needs might indicate barriers to accessing HCBS. Our findings indicate differences in predictors of unmet needs by service categories, which should inform future targeted policymaking by state agencies and service providers to improve HCBS.