# Impact of Financial Incentives on Setting of Care for Older Adults with Alzheimer's Disease and Related Dementias

> **NIH NIH R21** · RAND CORPORATION · 2020 · $375,087

## Abstract

Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) are irreversible neurocognitive
disorders characterized by progressive decline in memory, cognition, and the ability to live independently. The
public health burden of care for individuals with AD/ADRD is enormous, with national costs exceeding $277
billion in 2018, including $186 billion paid by Medicare and Medicaid. Despite such investments, coverage of
home and community-based services (HCBS) is often inadequate to meet the needs of community-dwelling
individuals with AD/ADRD. HCBS (e.g., home health care, personal care services) are likely to be costly than
institutional care, more consistent with patient wishes, and may result in better outcomes. Greater access to
HCBS may delay or replace the need for nursing home care, thus increasing the level of cognitive and
functional impairment that necessitates admission to a nursing home. Many state Medicaid programs have
begun to implement policies that incentivize a shift from institutional care to lower-cost HCBS. However, the
impact of financial incentives on setting of care (home versus institution) for older adults with AD/ADRD is not
well understood. The proposed study takes advantage of a natural experiment in New York state. Between
2012 and 2015, New York transitioned from fee-for-service delivery of HCBS to a managed long term care
(MLTC) model that shifted the responsibility for costs to managed care plans. All Medicaid beneficiaries
requiring more than 120 days of long term care were required to enroll in MLTC. The mandate was
implemented in phases, starting in New York City and gradually expanding to other areas of the state. This
natural experiment creates a unique opportunity to study the impact of financial incentives on setting of care
(home versus institution) for older adults with AD/ADRD. Older adults (aged 65+) who are dually eligible for
Medicare and Medicaid are affected by these incentives. Our team will leverage multiple longitudinal data
sources to accomplish the following aims: 1) Describe trends in coverage and utilization of long term care
services among older adults in New York state diagnosed with AD/ADRD between 2010 and 2019; 2) Evaluate
changes in the intensity of home health care and nursing home care (days per year) among dual eligible older
adults with AD/ADRD following implementation of MLTC mandates; 3) Evaluate changes in cognitive function
and functional status (ability to perform activities of daily living) among dual eligible older adults with AD/ADRD
admitted to home health care or nursing home following implementation of MLTC mandates. The goal of this
new investigator-initiated R21 is to provide policymakers and other stakeholders with rigorous analyses to
inform the design of financial incentives to improve delivery of long term care services for older adults with
AD/ADRD. Findings will inform development of an R01 to study the impact of financial incentives on long term
care util...

## Key facts

- **NIH application ID:** 10093198
- **Project number:** 1R21AG069787-01
- **Recipient organization:** RAND CORPORATION
- **Principal Investigator:** Jordan M Harrison
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $375,087
- **Award type:** 1
- **Project period:** 2020-09-30 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10093198

## Citation

> US National Institutes of Health, RePORTER application 10093198, Impact of Financial Incentives on Setting of Care for Older Adults with Alzheimer's Disease and Related Dementias (1R21AG069787-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10093198. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*