3D illustration of two rubber stamps with the words Mercicare and Medicaid over paper background.
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Older adults who are dually eligible for the Medicare and Medicaid programs are highly concentrated in assisted living communities, according to a research letter published in JAMA Health Forum.

The finding could represent “a disadvantage because Medicaid reimbursement rates are generally lower than private pay rates,” concluded the authors, from Brown University and Providence Veterans Administration Medical Center in Rhode Island. “Future research is warranted to evaluate assisted living care quality by the distribution of dually eligible adults.”

Almost one in five assisted living residents, the authors noted, relies on Medicaid to pay for personal care and supportive services. High concentrations of residents dually eligible for Medicare and Medicaid in nursing homes are associated with lower staffing levels and more state-identified deficiencies, they said.

The researchers’ findings come from a cross-sectional study of 2018 Medicare enrollment data, a national directory of licensed assisted living communities, and records of Medicaid state waivers and plans with assisted living coverage in 47 states. 

They used the data to look at the concentration of beneficiaries with Medicare and Medicaid dual eligibility in assisted living communities with 25 or more beds. The researchers also looked at the association with Medicaid financing of assisted living services. 

Of the 47,695 older adults living across 12,168 assisted living communities, 25% were enrolled in both programs, they found. Nationally, 78% of dually eligible individuals lived in just 20% of assisted living communities. In settings outside of assisted living, 19% of older adults were dually enrolled researchers said.

By state, Washington had the lowest concentration of dual-eligible older adults living in assisted living communities, whereas Alabama had the highest concentration.

States with no Medicaid financing for assisted living had the highest concentration of dually eligible residents, followed by states with Medicaid waivers. States that covered assisted living through a state plan — or through both a state plan and a waiver — had the lowest concentration of dually eligible residents. The authors noted that most states cover services in assisted living communities through Medicaid waivers.

The research was supported by the Patrick and Catherine Weldon Donaghue Research Foundation and the National Institute on Aging.