When Disparities and Differences in Resources Abound, Medicaid Acts as Stopgap

The need for Medicaid as stopgap coverage for long-term care is more apparent when looking at differences in race, gender and ethnicity, and rural versus urban status of the residents.

This is according to an analysis conducted by ATI Advisory, which identified the impact of disparities and differences in resources – finances, insurance and social supports – along with long-term outcomes for individuals aged 55 and older needing long-term services and supports (LTSS), including nursing home care.

“We’d [like to] emphasize just how much higher the prevalence of LTSS needs at age 55 was for Black and Hispanic individuals than for white individuals,” Nils Franco, senior analyst with ATI Advisory told SNN. “Black and Hispanic individuals tended to have remarkably fewer financial resources to afford LTSS when they needed it.”


In analyzing data from the University of Michigan Health and Retirement study, ATI researchers noted the uneven financial burden and decline in cognition faced by aging Blacks and HIspanics.

“Our longitudinal analyses reveal that financial challenges and cognitive decline take a disparate toll on Black and Hispanic individuals in the ten years after age 55,” he said.

Given these disparities, the study affirms that Medicaid coverage is an important resource for equitable access among groups with fewer resources, Franco said, both at age 55 and in the next decade of their life.


According to the study’s data, Black individuals aged 55 and older needed LTSS 114% more often than white individuals, the study found. And, Hispanic individuals needed such services 72% more than white individuals.

Overall, 15% of individuals aged 55 experienced LTSS needs, reflecting limitations in daily living as a result of functional or cognitive impairment, or intellectual or developmental disability.

However, Black and Hispanic/Latino individuals had health insurance coverage less often than white individuals – the insurance coverage for Blacks being 8% less and Hispanics 21% lower compared to white individuals.

Black and Hispanic/Latino people were also more likely to gain Medicaid coverage earlier between ages 55 and 65 compared to white individuals.

Meanwhile, those living in rural communities needed LTSS 23% more than people living in urban communities, researchers added. LTSS needs didn’t vary significantly by gender or sexual orientation, the study found.

Policy and program recommendations made in the study include promoting policies that reduce disparities in financial resources, along with mitigating barriers to Medicaid LTSS insurance coverage.

ATI researchers also suggested catering public programs to be better tailored to provide LTSS for individuals without in-home supports.

“Policymakers can leverage these findings to prioritize policies and programs that could yield long-term benefits among individuals with LTSS needs, particularly to improve equity in outcomes and LTSS access,” added researchers.

Compared to whites, Black individuals typically had approximately half the annual income of whites ($21,450 versus $39,165), and 9% of the total assets held by whites ($4,000 versus $45,800). And, Blacks had only 5% of non-housing assets compared to white individuals, or $500 versus $9,800, according to the study.

Hispanic individuals had about $22,000 in annual income, $5,000 in median total assets and $25 in median non-housing assets.

In terms of LTSS needs and utilization, cognitive decline differed significantly, researchers said, by race and ethnicity. Black individuals and Hispanic/Latino individuals experienced 214% and 178% higher rates of cognitive decline, respectively, compared to white individuals.

Activities of daily living functional decline and rates of nursing facility entry didn’t significantly differ by race and ethnicity, gender or geography, but prior research has found that Black individuals make up a larger share of individuals who lived in a nursing facility between the ages of 50 and 64, compared to those at ages 65 and older, ATI researchers noted.

For black individuals, bolstered access to LTSS coverage from Medicaid offers a resource that runs counter to disparities in personal finances and social supports as well, Franco told SNN.

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