Use of long-term services and supports among dual-eligible beneficiaries with Alzheimer's disease and related dementias.

backgroundTo 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).

methodsUsing 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.

resultsWe 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.

conclusionsOur 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.