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

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.