OTHER PROJECT INFORMATION – Project Summary/Abstract Project 4 – The Health Impact of Administrative Burdens for People with ADRD The lives of people living with Alzheimer’s disease and related dementias are challenging on multiple dimensions that are made further complicated by healthcare-imposed administrative burdens. People with ADRD struggle with both complex and simple memory and cognitive tasks that dominate their daily lives, often relying on overburdened family caregivers. ADRD also face many other, less-obvious challenges related to their health and well-being, including suffering from a variety of comorbidities, receiving lower quality care when accessing services to treat these conditions, and high levels of reliance on caregivers for navigating the complexities of the healthcare system. Further, doctors report challenges treating people with ADRD, including those related to working with the patient (due to time and communication constraints), those related to billing for services provided to people with ADRD, and helping them access specialist and social services. These challenges have the potential to make people with ADRD uniquely impacted by the administrative burdens and hassles imposed by the U.S. healthcare system. These hassles are pervasive. Patients and healthcare providers encounter these burdens nearly every time they interact with the system. They come in the form of billing hassles, prior authorization restrictions, complex applications for public insurance programs, and frequent eligibility redeterminations for the same programs. Prior work has documented that these burdens and hassles impose large financial, psychological, and time costs on patients and providers, but they may also affect patient health and well-being. Hassles associated with accessing care may make providers less willing to treat patients whose insurers are the most difficult to work with. Hassles associated with enrolling in and remaining enrolled in public insurance programs may result in incomplete take-up of these programs and high levels of churn in and out of coverage, possibly causing patients to forgo needed care. In this project, we will study the effects of these hassles on access to healthcare and health outcomes for people with ADRD. First, we will document the exposure of people with ADRD to these types of administrative burdens and compare them to those faced by other patients. Second, we will study burdens in accessing care, focusing on billing hassles and prior authorization restrictions. Third, we will study burdens in accessing Medicaid (especially long-term services and supports benefits). Administrative hassles represent another key influence on healthcare delivery, access, and disparities for people with ADRD and their families, complementing the study of innovative tools, race and ethnicity, pressured environments, and policy incentives in the other P01 projects.