# Impact of Medicare and Medicaid Financial Policies on Post-acute and Long-term Care for Persons Living with Dementia

> **NIH NIH R01** · BROWN UNIVERSITY · 2024 · $608,731

## Abstract

Project Summary: The current proposal, developed in response to RFA-AG-24-031 (Consortium for
Economic Research on AD/ADRD Prevention, Treatment, and Care) will leverage the last 15 years of
Medicare claims and clinical assessment data and econometric methods to advance our understanding of how
post-acute and long-term care use and health outcomes for persons living with ADRD are impacted by the
changing landscape of health care financing. The 6.7 million Americans living with ADRD are the most frequent
users of long-term care services. Unfortunately, the current long-term care system is characterized by
substantial barriers to access, variation in service quality, and potentially inefficient resource allocation across
community-based and institutional care settings. In nursing homes, the predominant institutional long-term care
setting, persons with ADRD often experience adverse care outcomes such as falls, avoidable hospitalization,
and excessive psychotropic medication use. Although home- and community-based care services (HCBS) are
an increasingly used alternative to institutional long-term care, the efficacy of HCBS for individuals with ADRD
is unclear and many barriers to accessing HCBS remain poorly understood. A signature feature of the long-
term care system is its reliance on post-acute care and more broadly, the involvement of multiple payers.
However, our understanding of recent significant changes to the Medicare and Medicaid financing landscape
on post-acute and long-term care utilization and outcomes is limited. Aim 1 of this proposal focuses on the
changing use of nursing home and home health services among persons with ADRD in the context of states’
expansion of HCBS funding and constraints on provider supply from certificate of need laws. Aim 2 focuses on
the evolution of MA in long-term nursing home care, a largely ignored area despite the explosive growth of the
MA program. This Aim also includes an evaluation of a potential promise of MA in long-term care: the
institutional special needs plans model. Aim 3 focuses on changes to a post-acute care revenue stream on the
quality of post-acute and long-term nursing home care. Post-acute care spending has been a consistent target
for saving Medicare dollars despite the importance of these funds for nursing home quality. Our study takes
advantage of federal policy that reduced cost-sharing revenues for nursing homes, but in application affected
nursing homes differently based on whether their state Medicaid programs had ‘lesser-of’ payment rules.
Completion of this entire project will be a significant contribution given the projected increase in the number of
people living with ADRD whose health outcomes may be sensitive to these financing and supply-side policies.
In addition, all project Aims include analyses that are focused on disparities in care utilization and outcomes by
race/ethnicity or Medicaid enrollment. Our results may inform future policy efforts to enhance and coordin...

## Key facts

- **NIH application ID:** 10977720
- **Project number:** 1R01AG089051-01
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** Cyrus M Kosar
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $608,731
- **Award type:** 1
- **Project period:** 2024-09-01 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10977720

## Citation

> US National Institutes of Health, RePORTER application 10977720, Impact of Medicare and Medicaid Financial Policies on Post-acute and Long-term Care for Persons Living with Dementia (1R01AG089051-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10977720. Licensed CC0.

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