# Home and Community-Based Service Use, Health Outcomes, and Health Care Costs for People with Alzheimer's Disease and Related Dementias

> **NIH NIH R01** · OREGON HEALTH & SCIENCE UNIVERSITY · 2024 · $444,028

## Abstract

Project Summary
Millions of low-income older adults require long-term services and supports (LTSS) but coverage of LTSS by
Medicare and private insurance is limited, leaving Medicaid as the primary payer for LTSS. In an effort to
respect people's preference for aging in place and to save costs, state Medicaid programs have turned to
policies designed to increase the use of home- and community-based services (HCBS), as an alternative to
nursing home care. Under this push towards HCBS, people with Alzheimer's disease and related dementias
(ADRD) have increasing opportunities to receive Medicaid HCBS. We propose to investigate HCBS use, health
outcomes, and health care costs among people with ADRD, particularly those with both Medicare and
Medicaid coverage.
Although HCBS use has increased nationwide for the past decades, HCBS use rates vary substantially across
states, suggesting the potential importance of state policies to encourage HCBS use. For example, state
Medicaid programs have different financial/functional eligibility and enrollment caps for HCBS users. However,
little is known about how these elements of state policies are associated with HCBS use. As state Medicaid
programs strive to increase HCBS use, there is a need for robust evidence about how different state Medicaid
policies are associated with HCBS use for people with ADRD.
Despite state Medicaid programs' push towards HCBS, these type of services may not be optimal for all people
with ADRD. HCBS use may meet people's preference for aging in place, but as people's ADRD progresses,
they may need more intensive round-the-clock care. Therefore, HCBS use for these people may lead to lower-
intensity care than needed, worse health outcomes, and higher health care costs (as a result of worse health
outcomes).
Our long-term goal is to identify elements of state Medicaid HCBS policies associated with an increase in
HCBS use by people with ADRD as well as to assess when HCBS is appropriately used to keep them safe in
the community. This proposal has four aims. First, we describe any use of HCBS, health outcomes
(hospitalization, emergency department visits, and falls), and health care costs for people with ADRD over time
(2016-2020) and across states. Second, we assess the association of state Medicaid HCBS policies with any
use of HCBS among people with ADRD. Third, we assess the effect of HCBS use on health outcomes for
people with ADRD across different levels of health status. Fourth, we assess the effect of HCBS use on health
care costs for people with ADRD across different levels of health status.
The proposed research will provide critical information about HCBS use, health outcomes, and health care
costs for people with ADRD. This knowledge will help inform state Medicaid policymakers who are seeking the
most effective approach towards HCBS and ultimately improve health outcomes for people with ADRD.

## Key facts

- **NIH application ID:** 10758003
- **Project number:** 4R01AG069782-02
- **Recipient organization:** OREGON HEALTH & SCIENCE UNIVERSITY
- **Principal Investigator:** HYUNJEE KIM
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $444,028
- **Award type:** 4N
- **Project period:** 2020-09-30 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10758003

## Citation

> US National Institutes of Health, RePORTER application 10758003, Home and Community-Based Service Use, Health Outcomes, and Health Care Costs for People with Alzheimer's Disease and Related Dementias (4R01AG069782-02). Retrieved via AI Analytics 2026-05-31 from https://api.ai-analytics.org/grant/nih/10758003. Licensed CC0.

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