# Medicare and Beneficiaries with Dementia

> **NIH NIH P01** · HARVARD MEDICAL SCHOOL · 2020 · $333,724

## Abstract

ABSTRACT
Millions of Americans have or will develop dementia, which has potentially dire implications for them, their
families, and the Medicare program. Beneficiaries with dementia already account for an estimated one in five
dollars of Medicare spending, yet the Medicare program has struggled to meet their complex medical and
supportive needs. Researchers' efforts to describe and improve the care Medicare beneficiaries with dementia
receive have been hampered by the difficulty of identifying those with dementia or cognitive impairments in
claims data, yet such data are currently the only data on Medicare beneficiaries that are available on a large
scale. Prior studies suggest that many beneficiaries have undetected or undiagnosed disease, while others
with intact cognition carry a false claims-based diagnosis. Accordingly, our first aim is to leverage linked survey
and claims data to predict the probability of dementia and its severity, according to a validated, survey-based
reference standard. Better identification of those with dementia is a prerequisite to obtain a more accurate
national picture of the care for this important population. The two data sources are also complementary; survey
data help assess under-diagnosis and the probability that a claim-based diagnosis truly represents dementia,
and claims data supports the examination of Medicare programs at scale. We will then describe the sorting of
Medicare beneficiaries across available plan options: Traditional Medicare (TM), Medicare Advantage (MA),
and within MA, Special Needs Plans (SNPs). This work builds on our existing P01 research on choice, which
demonstrated that beneficiaries with less cognitive ability were more likely to choose a dominated plan. In this
project, we will examine sorting with respect to options potentially advantageous for those with dementia, e.g.,
SNPs. Finally, we will examine dementia care and outcomes in the changing Medicare program as both
payments for dementia beneficiaries and benefit flexibility increase. For example, MA plans will receive
substantially larger payments for enrolled beneficiaries with dementia starting in 2020 through risk adjustment
formula changes, which coincides with new flexibility in offering LTSS because of the CHRONIC Care Act.
Additionally, reimbursement of skilled nursing facilities will change in late 2019 to weigh cognitive deficits more
and therapy minutes less. Our study will provide critically needed evidence about the role of incentives and
program flexibility for beneficiaries with dementia receiving care within Medicare in an era of change.

## Key facts

- **NIH application ID:** 9937245
- **Project number:** 2P01AG032952-11
- **Recipient organization:** HARVARD MEDICAL SCHOOL
- **Principal Investigator:** DAVID C GRABOWSKI
- **Activity code:** P01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $333,724
- **Award type:** 2
- **Project period:** — → —

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9937245

## Citation

> US National Institutes of Health, RePORTER application 9937245, Medicare and Beneficiaries with Dementia (2P01AG032952-11). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9937245. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*