"You've Got a Lot to Prove": A Mixed Methods Analysis of How Older Adults and Their Families Navigate Medicaid Enrollment.

Many older adults will need Medicaid to cover health and long-term care costs, yet the process by which these older adults gain access to Medicaid is poorly understood. In a case study of family caregivers and key program staff at a skilled nursing facility in a large, urban county in North Carolina, I document the experiences of older adults' families applying for Medicaid. Participants report challenges with the application process and their own assets creating barriers to enrollment, while having a health event requiring institutionalised care precipitated access. Given these results, I use data from 11 waves of the Health and Retirement Survey to test these hypothesised factors, demonstrating that prior hospitalisation and having limited assets both accelerate time to Medicaid enrollment. Expanding Medicaid to cover older adults with incomes greater than the federal poverty line and simplifying eligibility requirements and application processes can improve the well-being of older adults and their families.