{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:32:45Z","timestamp":1790800365281,"version":"4.1.0"},"reference-count":34,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"vor","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["alz-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alzheimer's &amp;amp; Dementia"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>INTRODUCTION<\/jats:title>\n                    <jats:p>Medicaid programs can support aging in place by paying for care provided by direct care workers (i.e., formal care) and providing financial support, education, and training to otherwise unpaid family members and friends (i.e., family care).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We used nationally representative data of adults 70 years and older with functional limitation(s)\u2014and the subsamples with dementia, enrolled in Medicaid, or rural residents\u2014and multinomial regressions to estimate the relationship between Medicaid waivers paying family caregivers and the types of care received.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Adjusting for demographics and family structure, living in a state with waiver payments for family caregivers decreased the probability of receiving formal care alone and increased the probability of receiving family care among persons living with dementia, Medicaid beneficiaries, and rural residents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>Understanding how policies incentivize caregiving has implications for broader discussions to (1) address workforce supply concerns and (2) mitigate economic consequences of family caregiving.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Medicaid Home and Community\u2010Based Services (HCBS) play a critical role in addressing the care needs of community\u2010dwelling older adults.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Medicaid programs paying family members for care reduced use of formal care.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>The relationship was strongest among persons with dementia, Medicaid, and rural residents.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>These findings have implications for workforce shortages and supports for caregivers.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.70715","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T03:26:00Z","timestamp":1758597960000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Shifting care patterns: How Medicaid policies shape family and formal care use"],"prefix":"10.1002","volume":"21","author":[{"given":"Johanna","family":"Thunell","sequence":"first","affiliation":[{"name":"Sol Price School of Public Policy University of Southern California  Los Angeles California USA"},{"name":"Schaeffer Center for Health Policy and Economics University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise M.","family":"Parrish","sequence":"additional","affiliation":[{"name":"Leonard Davis Institute of Economics University of Pennsylvania  Philadelphia Pennsylvania USA"},{"name":"Department of Sociology University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine E. M.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Bloomberg School of Public Health Johns Hopkins University  Baltimore Maryland USA"},{"name":"Roger and Flo Lipitz Center to Advance Policy in Aging and Disability Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,22]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.01800"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnad036"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhealeco.2012.10.006"},{"key":"e_1_2_7_5_1","unstructured":"KolodziejI CoeNB Van HoutvenCH.Intensive informal care and impairments in work productivity and activity (No. 1010). Ruhr Economic Papers;2023."},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.129.6.946"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gny049"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.168.19.2154"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/trc2.12082"},{"key":"e_1_2_7_10_1","unstructured":"Prevention CfDCa.Caregiving for Person with Alzheimer's Disease or a Related Dementia. Accessed February 19.https:\/\/www.cdc.gov\/aging\/caregiving\/alzheimer.htm.2019."},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14038"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2009.02631.x"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1037\/0882-7974.22.1.37"},{"issue":"1","key":"e_1_2_7_14_1","first-page":"19","article-title":"Addressing the diverse needs of unpaid caregivers through new health\u2010care policy opportunities","volume":"31","author":"Reyes AM","year":"2021","journal-title":"Public Policy Aging Rep"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18376"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1093\/haschl\/qxad041"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13809"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00019442-200405000-00002"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2010.02.009"},{"key":"e_1_2_7_20_1","volume-title":"The Kaiser Commission on Medicaid and the Uninsured","author":"Reaves EL","year":"2015"},{"issue":"2","key":"e_1_2_7_21_1","first-page":"159","article-title":"Medicaid 1915(c) home and community\u2010based services waivers across the states","volume":"22","author":"LeBlanc AJ","year":"2000","journal-title":"Health Care Financ Rev"},{"key":"e_1_2_7_22_1","volume-title":"An Overview of Long\u2010Term Services and Supports and Medicaid. Final Report","author":"Thach NT","year":"2018"},{"issue":"1","key":"e_1_2_7_23_1","first-page":"123","article-title":"Home and community\u2010based services waivers","volume":"22","author":"Duckett MJ","year":"2000","journal-title":"Health Care Financ Rev"},{"key":"e_1_2_7_24_1","author":"Reaves EL","year":"2015","journal-title":"Medicaid and Long\u2010Term Services and Supports: A Primer"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/07334648231158482"},{"key":"e_1_2_7_26_1","volume-title":"National Health and Aging Trends Study User Guide: Rounds 1\u201013 Final Release","author":"Vicki AF","year":"2024"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2022.00149"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/geroni\/igaf044"},{"key":"e_1_2_7_29_1","unstructured":"AARP Public Policy Institute.Innovation and Opportunity: A State Scorecard on Long\u2010Term Services and Supports for Older Adults People with Physical Disabilities and Family Caregivers 2023 Edition.2023.Long\u2010Term Services and Supports State Scorecard. September 2023.https:\/\/ltsschoices.aarp.org\/sites\/default\/files\/documents\/doi\/ltss\u2010scorecard\u20102023\u2010innovation\u2010and\u2010opportunity.doi.10.26419\u20102Fppi.00203.001.pdf"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/1468\u20100009.12567"},{"key":"e_1_2_7_31_1","volume-title":"Advancing Action: A State Scorecard on Long\u2010Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers","author":"Reinhard S","year":"2020"},{"key":"e_1_2_7_32_1","volume-title":"Classification of Persons by Dementia Status in the National Health and Aging Trends Study","author":"Kasper JD","year":"2013"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.14269"},{"key":"e_1_2_7_34_1","volume-title":"Medicaid Home & Community\u2010Based Services: People Served and Spending During COVID\u201019","author":"Watts MOM","year":"2022"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1111\/iere.12095"}],"container-title":["Alzheimer's &amp; Dementia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/alz-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/alz.70715","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/alz-journals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/alz.70715","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/alz-journals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/alz.70715","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T11:09:19Z","timestamp":1771153759000},"score":1,"resource":{"primary":{"URL":"https:\/\/alz-journals.onlinelibrary.wiley.com\/doi\/10.1002\/alz.70715"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":34,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1002\/alz.70715"],"URL":"https:\/\/doi.org\/10.1002\/alz.70715","archive":["Portico"],"relation":{},"ISSN":["1552-5260","1552-5279"],"issn-type":[{"value":"1552-5260","type":"print"},{"value":"1552-5279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]},"assertion":[{"value":"2024-12-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-22","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70715"}}