Who Pays for Care? Disability, Public Programs, and the Sources of Home Care at Midlife

• In Event: Public Health Insurance Programs: Cost Containment, Equity, and Care Burden Among Aging and Disabled Populations

Abstract

When adults become disabled during their working years, who helps them at home, and who pays? Public programs answer differently: one route to disability benefits carries immediate Medicaid eligibility and home-care coverage, while the other imposes a two-year wait for Medicare, followed by coverage limited to skilled care. Using the Health and Retirement Study, we compare adults aged 51–64 by program participation, including work-limited adults outside both programs, conditioning on functional need and household composition. Program participation raises the probability of receiving help mainly at low-to-moderate need, where care is discretionary. Paid-helper use is ordered by Medicaid access, with this advantage widening as limitations accumulate. Paid help complements rather than replaces family care, with spouse presence strongly predicting the paid/unpaid mix. Extending Medicaid-style home-care coverage to the Medicare-route population could increase paid help where families are most stretched without displacing care they already provide, particularly among adults with substantial functional limitations.

Authors

• Na Yin, Baruch College (City University of New York)
  Presenting Author

• Yinuo Guo, The City University of New York
  Non-Presenting Co-Author