Profile of Older Dual-Enrollees Living in Areas with Managed Long-Term Services and Supports.
Andrew D Jopson, Chanee D Fabius, Karen Shen and 2 others
PMID 38103571WHAT IT FOUND
56.2% of older adults on Medicare and Medicaid needing long-term care lived where managed long-term services were offered.
They averaged 2.89 helpers and nearly 70 weekly care hours. Areas with these programs had more Hispanic adults and less nursing-home or residential care living.
Key findings
0156.2% of older dual-enrollees with significant LTSS needs lived in counties with managed long-term services programs.
02Older dual-enrollees with significant LTSS needs commonly had multiple helpers and paid help: 78.5% had two or more helpers, 58.7% received paid help, and they averaged 2.89 helpers and nearly 70 hours of care per week.
03Counties with managed long-term services programs had a different older dual-enrollee profile: more Hispanic/other adults (50.5% vs 15.1%), less rural adults (8.7% vs 31.4%), and less residential care or nursing-home living (18.4% vs 34.7%), without observed health or disability differences.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study compared counties with or without managed LTSS programs, not participants' actual enrollment in those programs. It was cross-sectional, so it cannot show that managed LTSS programs caused the observed differences. The unweighted target sample was 275 older dual-enrollees, and care-hours data were available for 271 participants, which may limit power to detect small differences. The data are from 2015, and more states have offered managed LTSS programs since then. The study did not measure many programmatic features, such as provider networks and care partner assessments. It did not account for other Medicaid-funded long-term services and supports, such as state plan personal care services and waivers. Hours of care were missing for some helpers and were imputed using the NHATS strategy.
Declared interests
The supplied text does not include an author conflict-of-interest declaration. The journal metadata lists NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not read the lower facility living rate in areas with managed long-term services as proof the programs caused community living. This was a cross-sectional survey, and the study did not know whether participants were actually enrolled in those programs.