This grant proposal will explore critical questions about Medicaid and long-term care (LTC) policies, focusing on how federal and state-level variations affect access, quality, and equity in care. By examining the effectiveness of different federal policy levers and state-level Medicaid waivers, we aim to determine whether specific policies work better for particular subpopulations, such as dually eligible individuals, immigrant communities, or family caregivers. A central theme will be understanding how federal and state policies interact, particularly in coordinating Medicare and Medicaid benefits for dually eligible individuals, and identifying areas where overlap or gaps in coverage impact care outcomes.
We will also investigate the role of managed care in Medicaid and its implications for access to services, workforce outcomes, and care quality. Special attention will be given to ownership structures in the LTC sector, including the impact of market concentration and competition on workforce conditions and patient care. Further, we aim to explore how variations in Medicaid eligibility rules for LTC services and estate recovery policies affect equitable access and financial security for beneficiaries.
A key focus will be on home- and community-based services (HCBS) and efforts to rebalance care away from institutionalization. We will examine whether these policies achieve equitable outcomes across different populations and their broader implications for workforce sustainability, particularly for immigrant workers. Finally, we will study variations in state policies on paying family caregivers, including the practice of recruiting family members through agencies, to better understand how these policies influence both workforce supply and patient care.
By addressing these interconnected issues, this project seeks to provide policymakers with evidence-based insights to improve Medicaid's role in delivering high-quality, equitable, and sustainable long-term care.