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Serving Low-Income Seniors Where They Live: Medicaid's Role in Providing Community-Based Long-Term Services and Supports

Methods
This analysis uses data from the National Health and Aging Trends Study (NHATS), a longitudinal survey of Medicare beneficiaries ages 65 and older.† Participants are drawn from a nationally representative sample of Medicare beneficiaries and interviewed annually in-person. To keep the sample as large as possible, we used NHATS Round 1 data, reflecting the Medicare population in 2011. We subset the data to include only those who lived outside nursing facilities and completed the interview.

We stratified the analysis by age categories of 65-74, 75-84, and 85 and over.  Within each age category, we further stratified the analysis into dual eligibility/income groups, which included (i) dual eligible beneficiaries with income below 300% of the 2011 Supplemental Security Income (SSI) federal benefit rate (FBR), (ii) non-dual eligible beneficiaries with incomes below 300% SSI, who we call “low-income without Medicaid” throughout the analysis, and (iii) beneficiaries with incomes at or above 300% SSI, who we call “higher-income without Medicaid” throughout the analysis. We chose to use the 300% SSI break for income to reflect policy rules about which individuals may be eligible for Medicaid long-term care assistance.  Note that dual eligible beneficiaries account for a small share (<2%) of the higher income group, but we do not stratify the higher income group by dual eligibility status.

NHATS collects information about different sources of income as well as total income; for respondents who do not know or refuse to provide income information, the survey includes imputed income. If a person is single, does not live with a partner, or is separated, income includes only the respondent’s own income; if a person is married or living with a partner, income includes both the respondent’s income and their spouse’s/partner’s income. We randomly selected the variable ia1toincim5 from the 5 generated income variables and compared it to the 2011 monthly SSI FBR ($2,022 for an individual and $3,033 for a couple).

We excluded respondents who either refused or did not know if they were married because we were unable to ascertain which income threshold (single or married) to use in comparing their incomes to the 2011 SSI FBR. We also excluded participants who did not know or refused to answer their Medicaid enrollment status. The total number of respondents who could not be categorized into an income or coverage group due to missing data was 217, leading to a final sample size of 7,395.

First, we analyzed which participants have any LTSS need by looking at self-care/mobility and household activities. We identified participants as having an LTSS need if they reported having difficulty completing an activity or receiving help with an activity (for household activities help due to a health or functioning reason). Self-care/mobility activities include bathing, dressing, toileting, eating, getting out of bed, getting around inside, and getting outside. Household activities include laundry, shopping, meal preparation, banking, and medication management.

We then looked at socio-demographic characteristics and health status among those who had any LTSS need. All percentages in Tables 1 and 2 are from the non-nursing facility sample with any self-care or household activity need, except for “interior or exterior of the home needs repair/service/attention” and “has no one to talk to.” The former percentage is from the subset of non-nursing facility participants with an LTSS need whose home the interviewer observed.  The latter is from the subset of non-nursing facility participants with an LTSS need who completed the survey themselves, rather than through a proxy.

† Jill Montaquila, Vicki A. Freedman, Brad Edwards and Judith D. Kasper.   2012.  National Health and Aging Trends Study Round 1 Sample Design and Selection.  NHATS Technical Paper #1. Baltimore: Johns Hopkins University School of Public Health, http://www.nhats.org/scripts/sampleDesign.htm.

Issue Brief Tables

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