ArticleJournal of the American Medical Directors Association2025
Has Increased Medicaid Spending on Home- and Community-Based Services Reduced Unmet Needs in Activities of Daily Living Care among Community-Dwelling Older Adults with Dementia? Evidence from 2008 to 2020.
Article in Journal of the American Medical Directors Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Medicaid funds direct care for one in four dual-eligible older adults nationally, but state variation is 4-fold.Health affairs scholar · 2026Article
- State Medicaid spending for long-term services and supports (LTSS) and the self-reported health of spousal caregivers of community-dwelling older adults with dementia.Aging and health research · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
objectivesThis study aimed to examine the potential impact of Medicaid total long-term services and supports (LTSS) expenditures and the proportion allocated to home- and community-based services (HCBS) on unmet needs among community-dwelling older adults with dementia.
designThis is a retrospective study using nationally representative, longitudinal data and quasi-experimental approach. SETTING AND
participantsA total of 2722 respondent-waves of community-dwelling older adults who participated in at least 1 of the 7 waves of Health and Retirement Study interviews between 2008 and 2020 and were identified as having dementia.
methodsUnmet needs were assessed using a binary variable indicating whether respondents who reported difficulties with activities of daily living (ADL) did not receive the necessary assistance. Generalized linear models (GLMs) with a logit link function and binomial distribution, clustered at the individual level, were used for both bivariate and multivariable analyses. To address potential endogeneity, a 2-stage residual inclusion (2SRI) analysis was conducted using state education expenditures per pupil as an instrumental variable (IV). Additionally, the Durbin-Wu-Hausman (DWH) test was performed to assess endogeneity.
resultsBoth GLM and IV regressions indicated that an increase in the share of HCBS relative to total Medicaid LTSS expenditures was associated with a significant reduction in unmet ADL needs among dementia individuals (OR CONCLUSIONS AND IMPLICATIONS: A higher proportion of Medicaid LTSS expenditures allocated to HCBS can potentially reduce unmet needs for ADL among community-dwelling older adults with dementia, supporting efforts to shift long-term care from institutional to home- and community-based settings.
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Registered trials
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