For skilled nursing facilities, the findings underscore a fragile informal care infrastructure – when family support fails, SNF placement remains the primary transition point. SNFs operating in MLTSS states should recognize that dual enrollee admissions are often triggered by caregiver burnout rather than acute clinical need alone, making proactive payer relationships and community referral partnerships a strategic admissions priority for this population.
Managed Long-Term Services and Supports and Caregiving Among Dually Enrolled Older Adults
Managed Long-Term Services and Supports has been implemented by more than half of all state Medicaid programs, but knowledge of its scope and consequences for caregiving is limited. The weighted percentage of community-living, older dual enrollees receiving assistance who resided in areas with an MLTSS program increased from 39.4% in 2012 to 71.4% in 2022.
Participants received approximately 65.6 weekly care hours, primarily from unpaid family caregivers averaging 42.0 hours weekly, with unpaid care accounting for 80.9% of total care hours. Mean weekly care hours for those in areas with continuous MLTSS presence were higher than those in areas that added or had no MLTSS program presence (72.9 vs. 61.6 and 60.0 hours, respectively). Systems are needed to monitor the care experiences of patients and their caregivers.
— JAMA Network Open, 1 Aug. 2025
Jopson, Andrew D., Chanee D. Fabius, and Jennifer L. Wolff. “Managed Long-Term Services and Supports and Caregiving Among Dually Enrolled Older Adults.” JAMA Network Open, vol. 8, no. 8, 1 Aug. 2025, p. e2528006, doi:10.1001/jamanetworkopen.2025.28006. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2837849.
Dual Eligibles Still Rely Heavily on Family for Care Despite LTSS Program Expansion
A new study reveals that despite dramatic growth in managed care programs for older and sicker adults, families continue to shoulder the overwhelming burden of providing long-term care services.
…the research revealed that unpaid family caregivers remained the primary source of assistance throughout the study period. These family members provided an average of 42 hours of care per week, while the total care received by participants averaged 65.6 hours weekly from approximately 2.8 different caregivers.
— McKnight’s Long-Term Care News, 23 Aug. 2025
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