Medicaid Cost Savings of a Preventive Home Visit Program for
Disabled Older Adults
Sarah L. Szanton, PhD,*
Y. Natalia Alfonso, MS,
Bruce Leff, MD,*
Jack Guralnik, MD, PhD,
Jennifer L. Wolff, PhD,
Ian Stockwell, PhD,
Laura N. Gitlin, PhD,*
and David Bishai, PhD
BACKGROUND/OBJECTIVES: Little is known about
cost savings of programs that reduce disability in older
adults. The objective was to determine whether the Com-
munity Aging in Place, Advancing Better Living for Elders
(CAPABLE) program saves Medicaid more money than it
costs to provide.
DESIGN: Single-arm clinical trial (N = 204) with a com-
parison group of individuals (N = 2,013) dually eligible
for Medicaid and Medicare matched on baseline geo-
graphic and demographic characteristics, chronic condi-
tions, and healthcare use. We used ﬁnite mixture model
regression estimates in a Markov model.
SETTING: Baltimore, MD
PARTICIPANTS: Individuals aged 65 and older with
reported difﬁculty with at least one activity of daily living.
INTERVENTION: CAPABLE is a 5-month program to
reduce the health effects of impaired physical function in
low-income older adults by addressing individual capacity
and the home environment. CAPABLE uses an interprofes-
sional team (occupational therapist, registered nurse,
handyman) to help older adults attain self-identiﬁed func-
MEASUREMENTS: Monthly average Medicaid expendi-
ture and likelihood of high- or low-cost use of eight
healthcare service categories.
RESULTS: Average Medicaid spending per CAPABLE
participant was $867 less per month than that of their
matched comparison counterparts (observation period
average 17 months, range 1–31 months). The largest dif-
ferential reduction in expenditures were for inpatient care
and long-term services and supports.
CONCLUSION: CAPABLE is associated with lower likeli-
hood of inpatient and long-term service use and lower over-
all Medicaid spending. The magnitude of reduced Medicaid
spending could pay for CAPABLE delivery and provide fur-
ther Medicaid program savings due to averted services use.
CLINICAL TRIAL REGISTRATION: CAPABLE for Frail
dually eligible older adults NCT01743495 https://clinical-
trials.gov/ct2/show/NCT01743495 J Am Geriatr Soc 0:1–
Key words: Medicaid costs; health disparities; physical
function and costs
early 4 in 10 older adults have some difﬁculty perform-
ing at least one activity of daily living (ADL) such as
bathing, dressing, or walking.
These difﬁculties are associ-
ated with poor quality of life,
, and high health-
Being dependent on family or a paid aide for
these basic functional tasks is costly to families and society.
Medicaid ﬁnances the medication, outpatient visits,
inpatient copayments, and long-term care of 4.6 million
low-income older adults. Medicaid also pays for the health-
care use relating to functional difﬁculties through hospital-
izations and nursing home admissions.
accounts for 24.5% of state budgets, which it is likely will
rise as the number of older adults increases because of pop-
Currently accounting for 24.5% of state
budgets, this amount will likely rise as the number of older
adults increases. Low-income older adults are of policy
interest because they have poor health outcomes that affect
state budgets and federal spending through Medicare and
the federal match to state Medicaid spending.
To address functional difﬁculties and medical costs,
we designed the Community Aging in Place, Advancing
Better Living for Elders (CAPABLE) program. CAPABLE
extends a successful program called Advancing Better Liv-
ing for Elders (ABLE), which improved ADL ability and
quality of life and reduced mortality through occupational
therapy and home modiﬁcation.
In CAPABLE, we added
pain, medication, and depressive symptom management
From the *School of Nursing;
Bloomberg School of Public Health;
School of Medicine, Johns Hopkins University;
School of Medicine,
University of Maryland; and
Hilltop Institute, University of Maryland
Baltimore County, Baltimore, Maryland.
Address correspondence to Sarah Szanton, Johns Hopkins School of
Nursing, 525 N Wolfe street #424, Baltimore, MD 21205. E-mail:
See related editorial by Fortinsky et al.
JAGS 0:1–7, 2017
© 2017, Copyright the Authors
Journal compilation © 2017, The American Geriatrics Society 0002-8614/18/$15.00
MODELS OF GERIATRIC CARE,
QUALITY IMPROVEMENT, AND
trials.gov/ct2/show/NCT01743495 J Am Geriatr Soc
JAGS 66:614–620, 2018
2017, Copyright the Authors
2017, The American Geriatrics Society 0002-8614/17/$15.00