MHA1 The Economic Burden of Alzheimer's Disease to Medicaid in California (MEDI-CAL)

Abstract

State Medicaid programs may bear a large portion of the costs of Alzheimer's disease (AD), since they are the major public payers for nursing home care. Recent data on current spending by Medicaid for these patients are not available. OBJECTIVE: To document Medicaid spending in California for persons with AD. METHODS: This study was based on enrollment and claims data for a 10% random sample of Medi-Cal recipients 60+ years of age with Medicaid claims in 1995 (N=62,450). Using a prevalence-based cost-of-illness methodology, the cost of AD was estimated as the difference in average annual costs between persons with AD and/or dementia, and an age- and sex-matched comparison cohort. Dementia was included with AD, since the latter is difficult to diagnose, and may be coded more broadly as dementia in an administrative database. Multivariate analyses were undertaken to control for differences in factors other than age and sex, including comorbid conditions. RESULTS: A total of 2,575 patients with AD and/or dementia were identified, a prevalence of 4.1%. From the 59,875 remaining recipients, 2,575 matched controls were randomly selected. Several comorbid conditions were found to be more common in the group with AD and/or dementia. After adjustment, average annual payments were found to be $7,700 higher for the AD/dementia cohort ($14,500 versus $6,800 for the comparison cohort, p <0.01); 90% of which represented nursing home costs. CONCLUSIONS: A diagnosis of AD and/or dementia is associated with substantially higher Medicaid expenditures. Annual excess spending for AD and/or dementia for the Medi-Cal program may be as high as $200 million, or 10% of all expenditures for elderly recipients.