UNMET CARE NEEDS AMONG RURAL OLDER ADULTS

Older adults who are deemed ineligible to receive Medicaid waiver services are an invisible population, at-risk for adverse health outcomes. Using a mixed-method design, we analyzed data from two state agencies to identified factors associated with service use and mortality risk of 1,008 older Medicaid waiver applicants and interviews with eight rural waiver-ineligible individuals about their care needs. Waiver-ineligibility increased mortality risk (OR = 0.48, p < .001); rural-dwelling individuals were more likely to be waiver-ineligible (OR = .61, p = .001). Elders expressed concern about ongoing unmet needs. They relied on family, used multiple strategies to manage their care needs, and lacked future plans should their health decline. Low-income rural individuals with some functional limitations often fall through the eligibility gap for services. To reduce adverse health outcomes experienced by this ‘near risk’ population, accessible preventive services are needed to address needs before they become unmanageable.