Medicaid is a commonly used program patients in the United States with Alzheimer’s Disease and Related Dementias (ADRD) and their caregivers rely on to sustain long-term care and support. But what is the causal impact of getting on Medicaid in terms of quality of life for both the patient and the caregiver? This is what SPH-B faculty member Indrakshi Roy aims to discover.
An assistant professor in the Department of Epidemiology and Biostatistics, Roy was recently awarded a two-year Early Career-Research on Economics of Alzheimer’s/Dementia (EC-READ) grant from the National Bureau of Economic Research (NBER) in the amount of $50,000 to create a centralized database of various state Medicaid policies directly related to dementia.
“Most Medicaid policies are not dementia-specific,” says Roy. “A patient’s eligibility comes down to long-term service and support needs, personal finances that qualify someone or not, and other factors, but it has nothing to do with dementia.”
Roy says it is surprising, given that an average of 1 in 4 U.S. older adults with ADRD are on Medicaid. Despite the advances of research in ADRD treatments, medications and intervention research to slow down progression, Roy says long-term care is often the inevitable outcome, which is costly. While Medicare is universal across the country, Medicaid varies significantly by state in terms of eligibility criteria, the financial threshold by which an individual qualifies, and availability of long-term care services and support.
“Whether Medicaid has improved an individual’s situation or not is very difficult to study among older adults. Individuals with greater illness are more likely to use more healthcare and subsequently spend down to qualify, confounding analyses,” says Roy. “To design sound quasi-experimental studies, researchers need tools that leverage natural variation, such as state policy differences, but currently no centralized resource details how these rules affect people living with dementia.”
The database would then be a way in which Roy could conduct the second half of her research, which would be to determine if Medicaid plays a significant impact on alleviating the stress of the patient and caregiver once they have gone through the process of eligibility.
What makes the data-gathering process particularly difficult is that there is no data set currently in existence that has all the Medicaid state policies listed in one place. What Roy is creating specifically for patients with ADRD and their families would be the first of its kind.
“I am trying to identify policies that would be most relevant to dementia care, like home and community-based services, and putting it all in one place,” says Roy. “Then I would develop a generosity index to understand the variation in state policies that affect access and utilization.”
For instance, one state could cover fewer people but provide more services, whereas another could provide a broader range of coverage but limited-service access. Further complicating the issue is that many states have been expanding home and community-based services in terms of Medicaid policy—but without the evidence that these services are more effective, according to Roy.
“This push stems from the fact these services are cheaper than nursing home stays and most people want to age in place and stay home for as long as possible,” says Roy. “But even if a state expands their home and community-based services eligibility but there isn’t the workforce to support it, is it actually a benefit?”
Roy says one of her main goals with creating this database and index is to ensure that state decisions and policies being put in place to make Medicaid more affordable work to the benefit of the people on the program.
“Medicaid plays a big part when it comes to supporting people with ADRD,” says Roy. “We need to ensure that the changes that are being made to make it cheaper for states actually work effectively towards the patient’s needs.”
Read more about SPH-B faculty, staff, and students making a difference at go.iu.edu/48bx.