National Plan to Address Alzheimer's Disease: 2016 Update. Strategy 3.E: Assess and Address the Housing Needs of People with Alzheimer's Disease

08/01/2016

Picture of Housing and Health: Medicare and Medicaid Use Among Older Adults in HUD-Assisted Housing. ASPE and the U.S. Department of Housing and Urban Development (HUD) will be releasing a follow-up report to the 2014 Picture of Housing and Health: Medicare and Medicaid Use Among Older Adults in HUD-Assisted Housing. This second report, Picture of Housing and Health Part 2, analyzes health care utilization and spending, taking into account confounding factors. The first report found a high prevalence of chronic conditions and higher health care utilization for HUD-assisted Medicare beneficiaries compared to unassisted beneficiaries. The study sought to understand whether the higher utilization could be explained by the characteristics of the sample. This second report finds that after taking into account characteristics associated with health care utilization and payment, HUD-assisted Medicare beneficiaries do not consistently have higher utilization and payment for health care services than unassisted Medicare beneficiaries.

  • HUD-assisted Medicare-Medicaid enrollees were generally less likely to use certain Medicare-covered services, such as acute inpatient stays and SNF stays, and they had significantly lower Medicare FFS payments than unassisted Medicare-Medicaid enrollees.
  • However, HUD-assisted Medicare-Medicaid enrollees were much more likely to use Medicaid-covered community-based supportive services such as personal care services, durable medical equipment, and HCBS, and have higher Medicaid FFS payments.

     

This suggests that perhaps HUD-assisted Medicare-Medicaid enrollees were more aware of Medicaid-covered community-based supportive services than unassisted Medicare-Medicaid enrollees. While this indicates that HUD-assisted beneficiaries are not using more acute health care services than unassisted beneficiaries after controlling for confounding factors, they still represent a vulnerable group with a high prevalence of chronic conditions and disabilities. The study demonstrates that HUD-assisted Medicare-Medicaid enrollees may still be a fruitful target group for policy interventions, but that the interventions may vary depending on the type of Medicare beneficiary and the geographic location.

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Support and Services at Home Program. ASPE just posted a second report on the Support And Services at Home (SASH) program in Vermont. Early findings show a promising model of coordinated health and supportive services within affordable housing settings. Using claims data for a sample of Medicare FFS beneficiaries, the evaluation analyzed health care utilization and expenditures among SASH participants and a comparison group of Medicare beneficiaries living in affordable housing properties in Vermont. Relative to the growth of Medicare expenditures in the comparison group, growth in annual Medicare expenditures was lower by an estimated $1,536 per beneficiary among beneficiaries enrolled in SASH panels established before April 2012 (i.e., well-established panels). However, a little more than half of the participants in the sample are not yet experiencing a lower rate of growth in Medicare expenditures. Impact estimates in this report are based on the first 3 years of the implementation of the SASH program, from July 2011 through June 2014.

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Medicaid Innovation Accelerator Program. CMS is addressing Medicaid innovation in five areas: substance use, community integration, LTSS, physical/mental health integration, and complex care. A portion of this work will address Medicaid beneficiaries who, because of their health and/or social conditions, are vulnerable to experience high levels of costly and often preventable service utilization, and whose care patterns and costs are potentially impactable. Another focus is to increase tenancy-sustaining services, expand housing development partnership opportunities, and assist states with strategies that expand HCBS.

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Unlicensed Care Homes. ASPE just released a report examining unlicensed care homes. Unlicensed care homes provide room, board and some level of services for two or more unrelated individuals, but are not licensed or certified by the state. These homes often serve very vulnerable individuals such as individuals with serious mental illness or other disabilities, or older adults with functional limitations and limited financial resources. Some of these homes are legally unlicensed while others operate illegally. The goal of this exploratory study was to understand how unlicensed care homes function as a residential care option, the types of individuals who reside in them, their characteristics including quality and safety and the policies that influence the supply of and demand for these homes. While exploratory in nature, the findings highlight potential issues of safety, abuse and financial exploitation in unlicensed care homes.

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