By 2040 the adult population age 65+ are projected to grow to over 83 million people. The combination of an aging population with chronic conditions is expected to increase the demand for long term services and supports (LTSS), including home and community-based services (HCBS). This study will address whether rural beneficiaries with similar levels of functional and cognitive abilities are accessing HCBS at the same rate(s) as urban beneficiaries. Study findings will inform the need for policies that facilitate better use of HCBS in sparsely populated rural areas and that enable beneficiaries to remain in their homes as long as they are functionally and cognitively able to do so.

Data from the 2015-2022 Medicare Current Beneficiary Survey (MCBS) Cost Supplement and Access to Care files will be analyzed to examine the use of HCBS among rural versus urban Medicare and dual eligible beneficiaries. To the extent that the MCBS tracks the use of services across all payers, we will explore the use of HCBS paid for either privately or through Medicaid, and home health services covered by Medicare. This study will also examine rural-urban differences in the need for LTSS, as measured by needing assistance with at least one activity of daily living, such as eating or bathing, rates of HCBS use, the use of different types of HCBS (home health care or other residential services), and the impact of HCBS on subsequent use of emergent services such as hospitalizations and emergency department visits.