Medicaid Drives Home Health for Dementia Care

Medicaid beneficiaries with dementia are much more likely to rely on home health services than dementia patients without Medicaid, according to a Kaiser Family Foundation report released Monday.

Given that Medicare and other forms of payment tend to have limited home health care coverage, low-income seniors with dementia typically can’t afford such services without Medicaid assistance, according to the report. In fact, 64% of adults with dementia who have Medicaid benefits used home health services within the past year, as compared to 39% of adult dementia patients without it.

The report, which outlines Medicaid’s role for people with dementia living in the community, specifically highlights Medicaid spending and utilization for home health care. It states that on average, Medicaid pays an average of $10,805 for each adult enrollee with dementia each year, mostly for home health care.

For other services covered by Medicare and different payers, Medicaid enrollment doesn’t play as significant a role, according to the report.

For example, the two groups were about equally likely to have a usual source of care. They also had a similar number of office and inpatient visits in the past year, as well as a comparable number of prescriptions filled in the same time period.

The Affordable Care Act implemented Community First Choice, an option for states to provide attendant care services, supported by federal matching funds. As of September, only California, Maryland, Montana, Oregon and Texas offer these services, according to the report. The ACA also contributes time-limited federal funding for states to offer home health options, including case management and care coordination; Alabama, Washington, New York and Michigan are among the states that list dementia as a qualifying condition for enrollment in their home health programs.

The report further describes home and community-based services waivers that Medicaid beneficiaries with dementia might qualify for on a state-by-state basis. Massachusetts, for instance, has a waiver that aims to keep older beneficiaries from nursing homes through chore and companion services, along with dementia coaching. Meanwhile, Virginia has one that is limited to assisted living facility services, according to the report.

Moving forward, Medicaid will remain an essential player in funding care for low-income adults with dementia, according to the report.

“People with dementia will likely need paid care as their functioning declines, and in the absence of other viable public or private financing options, Medicaid will continue to be the nation’s primary payer for [long-term services and supports],” the report states.

Written by Kourtney Liepelt