# Policy options to improve access to memory care for disadvantaged individuals who are dually eligible for Medicare and Medicaid

> **NIH NIH R01** · UNIVERSITY OF SOUTHERN CALIFORNIA · 2024 · $630,824

## Abstract

Project Summary/Abstract
The proposed study will be the first to decompose how different institutional-, state- and patient-level
factors interfere with the access of elderly individuals dually eligible for Medicare and Medicaid
(“duals”) to memory care and provide actionable and state-specific policy guidance on how to address
these obstacles. Duals have a higher risk of Alzheimer’s disease (AD) and related dementias (ADRD),
given their lower income and education, as well as higher prevalence and worse management of chronic
conditions. Having partial Medicaid coverage, duals face the well-known reluctance of physicians to see
them, because of lower payment rates compared to those for Medicare-only beneficiaries, and
administrative complexity given that providers need to bill Medicaid and Medicare separately. Patient-
level factors, such as limited ability to navigate two separate benefit schemes, compound the challenge.
Consequently, duals are less likely to be diagnosed, counseled, and treated for cognitive impairment in
spite of their higher disease burden. As disease-modifying AD treatments are likely to become available
soon, understanding and addressing these obstacles becomes pressing to avoid potentially widening
existing disparities. The proposed study has three aims:
Investigate the association of disparities in receiving memory care between duals of similar predicted
risk of cognitive impairment with patient- (e.g., race/ethnicity) and state-level factors (e.g., provider
density).
Causally decompose the effects of physician payment rates, patient navigation, and administrative
complexity on access to memory care for duals compared to non-duals with similar cognitive
impairment risk. We will take advantage of differences in Medicaid rates across states and a 2022 policy
reform that aims to improve patient navigation and reduce administrative complexity for physicians.
Explore whether effects of physician payment rates, patient navigation, and administrative complexity
on access to memory care are moderated by patient- and state-level drivers of disparities, and provide
tailored and actionable policy guidance on how to effectively and efficiently improve access to memory
care for duals to all 50 states and the District of Columbia.

## Key facts

- **NIH application ID:** 10891729
- **Project number:** 5R01AG083189-02
- **Recipient organization:** UNIVERSITY OF SOUTHERN CALIFORNIA
- **Principal Investigator:** Soeren Mattke
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $630,824
- **Award type:** 5
- **Project period:** 2023-08-01 → 2028-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10891729

## Citation

> US National Institutes of Health, RePORTER application 10891729, Policy options to improve access to memory care for disadvantaged individuals who are dually eligible for Medicare and Medicaid (5R01AG083189-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10891729. Licensed CC0.

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