Health Equity in Long-Term Services and Supports: Robert Wood Johnson Foundation Project Results and Findings

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AUTHOR – ATI Advisory

Approximately 14 million adults in the United States need long-term services and supports (LTSS) to help with their cognitive and functional needs. How many of these individuals have access to LTSS? What are their experiences like? What are the disparities by race and ethnicity, gender, age, and sexual identity?

This project, supported by the Robert Wood Johnson Foundation, elevates the voices of individuals with lived experience and their caregivers, and illuminates systemic barriers that contribute to inequitable access to LTSS. The quantitative and qualitative analyses in the resources below detail differences in LTSS needs and access by various demographic characteristics.

Policy Solutions

Opportunities to Improve Health Equity in Long Term Services and Supports (LTSS) Through Medicare

Briefing on Improving Health Equity in LTSS Through Medicare

Focus on Specific Populations

Focus Group Brief: Health Equity Perspectives From Individuals Experiencing LTSS Needs

How Integrated Programs Can Address The Challenges Of Limited English Proficiency For Dual Eligible Individuals

Advancing Equity in Caregiving for Older LGBTQ+ Adults: Lessons Learned from Interviews with Advocacy Groups, Community-Based Organizations, and Health Plans

Data Spotlight of Older Lesbian, Gay, Bisexual, or Queer (LGBQ+) Individuals: Social Supports and Medicaid Coverage 

Data Findings

Disparities in LTSS Needs and Supportive Resources at Age 55, and Outcome Disparities During the Next Decade 

Access to LTSS-Like Supplemental Benefits Data Brief 

Disparities Among Medicare Beneficiaries Experiencing Difficulty with Activities of Daily Living 

New Data Shows Racial and Ethnic Disparities for Medicare Beneficiaries Who Have Difficulty with Activities of Daily Living

Recent Work


Health Equity Perspectives from Individuals Experiencing LTSS Needs, and their Caregivers, from Historically Marginalized Communities

ATI Advisory’s qualitative research highlights the experiences of individuals with long-term services and supports (LTSS) needs and their caregivers in requesting, receiving, and providing LTSS. Using a community-based participatory framework in partnership with local organizations, ATI conducted six focus groups interviewing individuals and caregivers from key populations across race, ethnicity, language ability, gender identity, sexual orientation, and disability status about their experiences with LTSS. Discussions generated themes around barriers to accessing LTSS, insights on family and professional caregiving across cultures, financial constraints, the value of social community for individuals and their caregivers, and the impacts of equitable and inequitable LTSS. This work was supported by the Robert Wood Johnson Foundation.
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Pharmaceutical Innovation and the Inflation Reduction Act: 2023 in Review 

We’re back for our half-year check-in on pharma R&D, our first since CMS selected the first 10 drugs for Medicare negotiation. In this report, we examine how 19 of the largest biopharma companies approached investment in R&D, M&A, and licensing in 2023.
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Data Spotlight of Older Lesbian, Gay, Bisexual, or Queer (LGBQ+) Individuals: Social Supports and Medicaid Coverage 

ATI Advisory research highlights demographic differences in supportive resources, including social supports and Medicaid coverage, among older LGBQ+ adults. This research also notes differences in supportive resources between older LGBQ+ and non-LGBQ+ individuals. Relationships with children, co-residents in the home, and the prevalence of having a partner in the home are common forms of unpaid in-home support and caregiving for older adults. This data spotlight analyzes the differences in these supports and additionally discusses differences in Medicaid coverage since Medicaid is the primary payer for long-term services and supports. In addition to this data spotlight, a brief highlights recommendations from advocacy groups, community-based organizations, and health plans who serve LGBTQ+ adults.
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