This paper examines whether Medicaid expansion following implementation of the Affordable Care Act (ACA) causes an increase in the proportion of people admitted to nursing homes who have Alzheimer’s disease or dementia using a difference-in-differences model and data from the American Community Survey (ACS), the Bureau of Economic Analysis (BEA), and LTCFocus. This proportion is found to increase by 0.749 percentage points or 2.72 percent in response to Medicaid expansion, based on conditional difference-in-difference estimation with staggered implementation.

This analysis makes use of HRS data to examine characteristics of older Americans with dementia and their mode of residence. Both Alzheimer’s and other forms of dementia are included in the analysis which shows that the prevalence of dementia increases with age. Additionally, dementia is associated with specific co-morbidities known to be related to the disease processes associated with it such as hypertension and stroke. Those with dementia also have more difficulty performing Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) than others. Individuals with dementia are more likely to live in formal care settings so they are disproportionately clustered in that setting. In addition, their financial standing is also lower than for other older adults and they have a greater tendency to receive health care through Medicaid. The association of dementia and other measures considered in the study with residence in a formal care setting is explored with linear probability models (LPM) that show a diagnosis of dementia, the number of helpers last month, and the number of ADL and IADL performed with difficulty are most predictive of residence in a formal care setting.