P1‐590: COME TO YOUR SENSES ‐ DEMENTIA‐SENSITIVE DESIGN SAVES MONEY!

Background:Medicare beneficiaries with dementia are more than twice as likely than those without dementia to be dually eligible for Medicaid coverage. Despite its importance in covering the cost of care for individuals with dementia, Medicaid use and expenditures have largely been excluded from research on dementia cost. In this study, we examined both Medicare and Medicaid utilization and expenditures in a largely minority cohort of individuals who have been carefully assessed clinically for dementia. Methods: The analysis sample included 568 Medicare beneficiaries who also had full Medicaid coverage (dual eligibles) enrolled in the Washington Heights-Inwood Columbia Aging Project (WHICAP), a multiethnic, population-based, prospective study of cognitive aging of Medicare beneficiaries age 65 and older residing in northern Manhattan. Individuals’ dementia status was determined using a rigorous clinical protocol. Medicare expenditures were obtained from Medicare Standard Analytic Files (SAFs). Medicaid expenditures were obtained fromMedicaid Analytic eXtract data (MAX) from New York state. A generalized linear model was used to estimate excess Medicaid spending due to dementia after controlling for patients’ clinical and demographic characteristics. Results: 228 individuals (40.1%) were diagnosed with dementia and 340 (59.9%) without dementia. Average annual Medicaid expenditures were more than twice as high in individuals with dementia ($50,270 in 2018$) than those without dementia ($21,966, p<0.001), particularly for personal care ($12,693 vs. $4,713), home health care ($6,838 vs. $2,850), and long term care ($6055 vs. $203, all p<0.01) services. There was no overall difference in average annual Medicare expenditure for individuals with and without dementia ($9,324 vs. $8,458, p1⁄40.19). However, individuals with dementia incurred higher Medicare expenditures for home health care than those without dementia ($1,240 vs. $695, p<0.001). Conclusions: These results provide important insight regarding the cost of dementia in a diverse, extremely vulnerable population who were dual eligible beneficiaries. Studies that do not include Medicaid costs are unlikely to accurately reflect the true cost of dementia. Policymakers will be challenged to meet the needs of this growing population while managing cost. P1-590 COME TO YOUR SENSES DEMENTIASENSITIVE DESIGN SAVES MONEY!