Date of Conferral

2021

Degree

Doctor of Public Administration (D.P.A)

Advisor

Gema G. Hernandez

Abstract

The United States is on a trajectory to reach 20% of citizens aged 65 and over by 2030. This hyper-aging population affects the costs of healthcare, but it is not adequately represented in current U.S. models. Studies indicate other hyper-aged nations have experienced this increase and implemented long-term care measures to counter the increase in aging populations and costs with system responsiveness. This study examined the role of Medicaid home -and community- based service (HCBS) contributions in states that have the fastest-aging populations. Using the established framework and data collected by the Centers for Medicare and Medicaid, the study looked for whether activities of daily living (ADL) and instrumental activities of daily living (IDAL) were statistically significantly associated with average costs per Medicaid 1915(c) aged recipient in Alaska, Nevada, and Utah, the highest hyper-aging states, which is defined as those with over a 20% increase in age 65 and over from 2000-2010. These states also had to have an established qualifying Medicaid 1915 (c) program. Using a total sample of 267 recipients equally distributed for Alaska, Nevada, and Utah, ADL and IADL were examined with overall average cost per recipient. The findings indicated positive correlations between ADL and IADL and costs in hyper-aging states. However, a single strong predictor variable could not be identified. The results offer insights into future utilization of ADL and IADL in HCBS study. The findings can be used by researchers to help identify significant predictors that can improve the costs associated with the long-term care of the elderly as the United States reaches hyper-aged status in 2030 and Medicaid HCBS use continues to grow.

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