This 50-page Issue Paper by Janet O'Keefe of the Public Policy Institute analyzed 42 states' Medicaid level-of-care (LOC) criteria to determine if they present barriers to nursing home care and HCB waiver services for persons with dementia who need LTC services. Using the two functional eligibility criteria recommended by the Advisory Panel on Alzheimer's Disease as a framework for the analysis, the study determined whether meeting the recommended eligibility criteria was sufficient to meet states' LOC criteria. Only 26 of the states surveyed have LOC criteria that recognize to some degree the unique LTC needs of people with dementia. However, even in states that consider the recommended criteria to be sufficient to meet the LOC criteria, individuals with functional limitations due to dementia may still not be eligible for services if they do not have the specific type, number, and severity of functional limitations required. The findings indicate that people with dementia will find it much easier to qualify for Medicaid nursing home and HCB waiver services in some states than in others. This variability raises major equity concerns. The study includes an appendix describing the features of 42 states' level-of-care criteria that are relevant for persons with dementia.
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Full Report (PDF)