# Impact of state HCBS generosity on dementia outcomes and disparities

> **NIH NIH R01** · UNIVERSITY OF ROCHESTER · 2022 · $378,818

## Abstract

Project Summary/Abstract
 Nearly 6 million people in the United States currently live with Alzheimer's disease or related dementia
(ADRD) and this number will be more than doubled by 2050. Patients with ADRD have difficulties with
memory, language, problem-solving and other cognitive skills that affect their abilities to perform daily
activities. Since over 70% of older patients with ADRD live at home and receive the majority of their care in the
community, appropriate home- and community-based services (HCBS) for patients with dementia are critical to
meet their preference to age in place, avoid unnecessary institutional care use, and reduce caregiver burdens.
About 19% of older adults live in rural areas in the US, and older adults living in rural areas tend to have higher
rate of dementia and worse cognitive functioning performance than those living in urban areas. Moreover,
about 24% of community-living older adults with ADRD are low income and qualify for state Medicaid financial
eligibility criteria, and an increasing percentage of people with ADRD are racial/ethnic minorities. A vast body
of literature in the past several decades has reported rural-urban, racial/ethnic, and income disparities in
important health outcomes, such as unmet needs for basic daily activities, and hospitalizations among
community-living older adults with ADRD. These disparities persist in recent years. The two major state
programs that support HCBS for older/disabled adults – Medicaid long-term services and supports (LTSS)
coverage and Title III programs under the Older Americans Act (OAA) of 1965 – are shown to help improve
health outcomes and quality of life for community-living older adults. These two programs together target low-
income aged/disabled persons and others with the greatest economic and social needs. It is thus expected that
the increased generosity of the two state HCBS programs will benefit the most vulnerable subgroups of older
adults in particular, such as those with severe cognitive impairments or rural residents, and help reduce
disparities in health outcomes. However, empirical evidence does not exist on whether more generous state
HCBS policies help reduce the differences in health outcomes between ADRD and non-ADRD patients or
redress the persistent outcome disparities related to rural residence, race/ethnicity, and poverty among
community-living ADRD patients. This study proposes to fill this knowledge gap by determining the longitudinal
and cross sectional impact of overall state generosity in supporting HCBS through the two major programs, as
well as the generosity of individual subtypes of HCBS programs (e.g. home-delivered meals under the OAA),
on gaps in health outcomes among a nationally representative sample of Medicare beneficiaries (age≥65
years) with or without ADRD living in the community. Findings of this project will illuminate the ways with which
major state HCBS policies impact the equity and outcomes of care received by c...

## Key facts

- **NIH application ID:** 10461867
- **Project number:** 5R01AG069733-03
- **Recipient organization:** UNIVERSITY OF ROCHESTER
- **Principal Investigator:** YUE LI
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $378,818
- **Award type:** 5
- **Project period:** 2020-09-30 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10461867

## Citation

> US National Institutes of Health, RePORTER application 10461867, Impact of state HCBS generosity on dementia outcomes and disparities (5R01AG069733-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10461867. Licensed CC0.

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