{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T10:57:59Z","timestamp":1769857079075,"version":"3.49.0"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>New York State\u2019s Medicaid managed long-term care (MLTC) program expanded access to home- and community-based services, providing an alternative to nursing home care for people with dementia. Between 2012 and 2015, the state implemented mandatory MLTC for dual Medicare and Medicaid enrollees requiring more than 120 days of community-based long-term care.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate changes in nursing home use among older adults with dementia following MLTC implementation.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study used longitudinal data from January 1, 2011, to December 31, 2019, from the Minimum Data Set and Medicare administrative data. The study sample included New York State Medicare beneficiaries 65 years and older with dementia. New York City residents were excluded due to insufficient pre\u2013study period data. Data were analyzed from January 1, 2011, to December 31, 2019.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Mandatory MLTC enrollment.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Longitudinal models were used to evaluate changes in annual days of nursing home use following the staggered implementation of MLTC across 13 regions of the state. Two models were estimated: (1) a logistic regression model for any nursing home use in a given year and (2) a linear regression model of total nursing home days, conditional on any nursing home use. Models included annual event-time indicators specified as years until or since MLTC implementation. To capture MLTC effects for dual enrollees relative to non\u2013dual Medicare enrollees, models included interaction terms for dual enrollment and event-time indicators.<\/jats:p><\/jats:sec>Results<\/jats:title>This sample included 463\u202f947 Medicare beneficiaries with dementia who lived in New York State between 2011 and 2019 (50.2% younger than 85 years; 64.4% women). Implementation of MLTC was associated with lower odds of nursing home use among dual enrollees, ranging from 8% lower odds 2 years post implementation (adjusted odds ratio, 0.92 [95% CI, 0.86-0.98]) to 24% lower odds 6 years post implementation (adjusted odds ratio, 0.76 [95% CI, 0.69-0.84]). Compared with a scenario of no MLTC, MLTC implementation was associated with an 8% reduction in annual days of nursing home use between 2013 and 2019 (mean, \u22125.6 [95% CI, \u22126.1 to \u22125.1] days per year).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The findings of this cohort study suggest that implementation of mandatory MLTC in New York State was associated with less nursing home use among dual enrollees with dementia and that MLTC may help prevent or delay nursing home placement among older adults with dementia.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.22520","type":"journal-article","created":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T15:13:55Z","timestamp":1689002035000},"page":"e2322520","source":"Crossref","is-referenced-by-count":7,"title":["Changes in Nursing Home Use Following Medicaid-Supported Expanded Access to Home- and Community-Based Services for Older Adults With Dementia"],"prefix":"10.1001","volume":"6","author":[{"given":"Jordan M.","family":"Harrison","sequence":"first","affiliation":[{"name":"RAND Corporation, Pittsburgh, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Flora","family":"Sheng","sequence":"additional","affiliation":[{"name":"RAND Corporation, Arlington, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raina E.","family":"Josberger","sequence":"additional","affiliation":[{"name":"New York State Department of Health, Albany, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harry H.","family":"Liu","sequence":"additional","affiliation":[{"name":"Analytica Now LLC, Brookline, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia W.","family":"Stone","sequence":"additional","affiliation":[{"name":"Center for Health Policy, Columbia University School of Nursing, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 A.","family":"Luchsinger","sequence":"additional","affiliation":[{"name":"Department of Medicine, Columbia University Irving Medical Center, New York, New York"},{"name":"Department of Epidemiology, Columbia University Irving Medical Center, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew W.","family":"Dick","sequence":"additional","affiliation":[{"name":"RAND Corporation, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10","published-online":{"date-parts":[[2023,7,10]]},"reference":[{"issue":"10","key":"zoi230667r3","doi-asserted-by":"publisher","first-page":"1637","DOI":"10.1377\/hlthaff.2015.0510","article-title":"US prevalence and predictors of informal caregiving for dementia.","volume":"34","author":"Friedman","year":"2015","journal-title":"Health Aff (Millwood)"},{"issue":"4","key":"zoi230667r4","doi-asserted-by":"publisher","first-page":"1008","DOI":"10.1037\/a0029857","article-title":"The natural history of cognitive decline in Alzheimer\u2019s disease.","volume":"27","author":"Wilson","year":"2012","journal-title":"Psychol Aging"},{"issue":"12","key":"zoi230667r5","doi-asserted-by":"publisher","first-page":"2087","DOI":"10.1111\/jgs.2013.61.issue-12","article-title":"Unmet needs of community-residing persons with dementia and their informal caregivers: findings from the Maximizing Independence at Home study.","volume":"61","author":"Black","year":"2013","journal-title":"J Am Geriatr Soc"},{"issue":"12","key":"zoi230667r6","doi-asserted-by":"publisher","first-page":"1475","DOI":"10.1001\/jama.288.12.1475","article-title":"Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study.","volume":"288","author":"Lyketsos","year":"2002","journal-title":"JAMA"},{"issue":"4","key":"zoi230667r8","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1002\/alz.v18.4","article-title":"2022 Alzheimer\u2019s disease facts and figures.","volume":"18","author":"Alzheimer\u2019s Association","year":"2022","journal-title":"Alzheimers Dement"},{"issue":"7","key":"zoi230667r10","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1377\/hlthaff.2018.05409","article-title":"A national examination of long-term care setting, outcomes, and disparities among elderly dual eligibles.","volume":"38","author":"Gorges","year":"2019","journal-title":"Health Aff (Millwood)"},{"issue":"10","key":"zoi230667r11","doi-asserted-by":"publisher","first-page":"852","DOI":"10.1016\/j.jamda.2018.05.017","article-title":"Socioeconomic and geographic disparities in accessing nursing homes with high star ratings.","volume":"19","author":"Yuan","year":"2018","journal-title":"J Am Med Dir Assoc"},{"issue":"3","key":"zoi230667r12","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1177\/0164027518824117","article-title":"Long-term services and supports use among older Medicare beneficiaries in rural and urban areas.","volume":"41","author":"Coburn","year":"2019","journal-title":"Res Aging"},{"issue":"5","key":"zoi230667r13","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1177\/0164027515622244","article-title":"Rebalance without the balance: a research note on the availability of community-based services in areas where nursing homes have closed.","volume":"39","author":"Tyler","year":"2017","journal-title":"Res Aging"},{"issue":"4","key":"zoi230667r14","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1016\/j.jamda.2019.01.120","article-title":"Rural-urban disparities in access to home- and community-based services and supports: stakeholder perspectives from 14 states.","volume":"20","author":"Siconolfi","year":"2019","journal-title":"J Am Med Dir Assoc"},{"issue":"1","key":"zoi230667r22","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1186\/s12913-017-2318-9","article-title":"Comparison of methods to identify long term care nursing home residence with administrative data.","volume":"17","author":"Goodwin","year":"2017","journal-title":"BMC Health Serv Res"},{"issue":"4","key":"zoi230667r23","doi-asserted-by":"publisher","first-page":"807","DOI":"10.3233\/JAD-2009-1099","article-title":"The accuracy of Medicare claims as an epidemiological tool: the case of dementia revisited.","volume":"17","author":"Taylor","year":"2009","journal-title":"J Alzheimers Dis"},{"issue":"3","key":"zoi230667r28","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1111\/hesr.2014.49.issue-3","article-title":"The association between long-term care setting and potentially preventable hospitalizations among older dual eligibles.","volume":"49","author":"Wysocki","year":"2014","journal-title":"Health Serv Res"},{"issue":"6","key":"zoi230667r29","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1111\/hesr.v55.6","article-title":"Outcomes of Medicaid home- and community-based long-term services relative to nursing home care among dual eligibles.","volume":"55","author":"Konetzka","year":"2020","journal-title":"Health Serv Res"},{"key":"zoi230667r9","volume-title":"The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff","author":"National Academies of Sciences, Engineering, and Medicine","year":"2022"},{"key":"zoi230667r1","unstructured":"Thach? NT, Wiener? JM. An overview of long-term services and supports and Medicaid: final report. August 7, 2018. Accessed December 1, 2022. https:\/\/aspe.hhs.gov\/reports\/overview-long-term-services-supports-medicaid-final-report-0"},{"key":"zoi230667r2","unstructured":"Super? N, Ahuja? R. Reducing the cost and risk of dementia. October 29, 2019. Accessed December 1, 2022. https:\/\/milkeninstitute.org\/report\/reducing-cost-and-risk-dementia"},{"key":"zoi230667r7","unstructured":"Lepore? M, Ferrell? A, Joshua Wiener? BM. Living arrangements of people with Alzheimer\u2019s disease and related dementias: implications for services and supports issue brief. October 2017. Accessed December 1, 2022. https:\/\/aspe.hhs.gov\/sites\/default\/files\/private\/pdf\/257966\/LivingArran.pdf"},{"key":"zoi230667r15","unstructured":"Watts? MO, Musumeci? M, Chidambaram? P. Medicaid home and community-based services enrollment and spending. February 4, 2020. Accessed December 1, 2022. https:\/\/www.kff.org\/medicaid\/issue-brief\/medicaid-home-and-community-based-services-enrollment-and-spending\/"},{"key":"zoi230667r16","unstructured":"Musumeci? M, Watts? MO, Chidambaram? P. Key state policy choices about Medicaid home and community-based services. February 4, 2020. Accessed December 1, 2022. https:\/\/www.kff.org\/medicaid\/issue-brief\/key-state-policy-choices-about-medicaid-home-and-community-based-services\/"},{"key":"zoi230667r17","unstructured":"Kasten? J, Lipson? D, Saucier? P, Libersky? J. Who enrolls in Medicaid managed care programs that cover long-term services and supports? implications of enrollee diversity for a national cross-state evaluation. June 2017. Accessed December 1, 2022. https:\/\/www.medicaid.gov\/medicaid\/downloads\/1115-ib1-508-mltss-enrollment.pdf"},{"key":"zoi230667r18","unstructured":"Lewis? E, Eiken? S, Amos? A, Saucier? P. The growth of managed long-term services and supports programs: 2017 update. January 29, 2018. Accessed December 1, 2022. https:\/\/www.medicaid.gov\/medicaid\/downloads\/mltssp-inventory-update-2017.pdf"},{"key":"zoi230667r19","unstructured":"Libersky? J, Liu? S, Turoff? L, . Managed long-term services and supports: interim evaluation report. January 31, 2018. Accessed December 1, 2022. https:\/\/www.mathematica.org\/publications\/managed-long-term-services-and-supports-interim-evaluation-report"},{"key":"zoi230667r20","unstructured":"Wysocki? A, Libersky? J, Gellar? J, . Medicaid managed long-term services and supports: summative evaluation report. November 24, 2020. Accessed December 1, 2022. https:\/\/www.medicaid.gov\/medicaid\/section-1115-demonstrations\/downloads\/mltss-summeval-rep.pdf"},{"key":"zoi230667r21","unstructured":"New York State Department of Health. Managed long term care (MLTC). Revised March 2023. Accessed December 1, 2022. https:\/\/www.health.ny.gov\/health_care\/managed_care\/mltc\/"},{"key":"zoi230667r24","unstructured":"Liu? HH, Dick? AW, Qureshi? N, . New York State 1115 demonstration independent evaluation: interim report. RAND Corporation; 2021. Accessed December 1, 2022. https:\/\/www.rand.org\/pubs\/research_reports\/RRA951-1.html"},{"key":"zoi230667r25","unstructured":"New York State Department of Health. Consumer Directed Personal Assistance Program (CDPAP). Updated November 2022. Accessed December 1, 2022. https:\/\/www.health.ny.gov\/health_care\/medicaid\/program\/longterm\/cdpap.htm"},{"key":"zoi230667r26","unstructured":"New York State Division of the Budget. New York State FY 2021 executive budget. Accessed December 1, 2022. https:\/\/www.governor.ny.gov\/sites\/default\/files\/atoms\/files\/FY2021BudgetBook.pdf"},{"key":"zoi230667r27","unstructured":"Fabius? CD, Wolff? JL, Willink? A, Skehan? ME, Mulcahy? J, Kasper? J. Community-based long-term services and supports: are the needs of older adults and their caregivers being met? October 27, 2021. Accessed December 1, 2022. https:\/\/www.commonwealthfund.org\/publications\/issue-briefs\/2021\/oct\/community-based-long-term-services-and-supports-are-needs-older"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2807111\/harrison_2023_oi_230667_1688131472.61329.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T15:14:02Z","timestamp":1689002042000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2807111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,10]]},"references-count":29,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,7,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.22520","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,10]]}}}