Enrollment in PACE is associated with lower risk of long-term nursing home admissions compared to receiving home- and community-based services through a 1915(c) waiver.

Background

To meet the long-term services and supports (LTSS) needs and preferences of older adults enrolled in Medicaid, states are increasingly supporting uptake of home- and community-based services (HCBS) to reduce the need for institutional care. Two ways that states provide HCBS is through Program of All-Inclusive Care for the Elderly (PACE) and 1915(c) waiver programs. This study assesses PACE’s impact on the risk of long-term nursing home admission compared to 1915(c) waiver programs among individuals dually eligible for Medicare and Medicaid in 12 states.

Findings

This study compared long-term nursing home admissions among 4,733 dually eligible enrollees in PACE to 97,035 dually eligible enrollees in 1915 (c) waiver programs. The analysis included people enrolled in one of these programs between 2005 and 2007 and assessed nursing home admissions through 2009. PACE enrollees had 31% lower risk of long-term nursing home admissions than those served through waiver programs. For those admitted to nursing homes, the study also assessed cognitive and functional impairment at admission. Compared to waiver program enrollees, PACE enrollees had higher levels of cognitive impairment, 55% higher odds of severe cognitive impairment, and 45% higher odds of high cognitive or functional impairment at admission.

Program/Policy Takeaways

PACE may more effectively help older adults, particularly those with cognitive and functional impairment, remain in the community and reduce long-term nursing home stays than 1915 (c) waiver programs. More research is needed to understand which features of PACE most impact health outcomes. Policymakers may consider how to expand PACE or similar programs to increase the use of HCBS.