New research from NORC at the University of Chicago is highlighting a growing group of middle-income older adults unable to access senior living care.

Approximately 6.5 million older adults – about 12% of the current population of people 65 and older – experience financial insecurity and navigate complex health care needs but have limited resources for securing long-term care, according to new research from the NORC at the University of Chicago.

While they are old enough to qualify for Medicare, they are just out of range of eligibility for Medicaid services, putting out of reach many of the services they will likely need as they age due to cost. Researchers identified the segment of older adults as “near-duals,” named for their status as almost eligible for both Medicare and Medicaid.

The new research underscores the need for more middle-market senior living models, and shows how at-risk older adults will continue to face care access issues without new solutions from legislators.

“This research exposes a critical gap in our current system of funding long-term care,” said Dianne Munevar, vice president of Health Care Strategy at NORC. “As a growing number of Americans reach older age, future policy should be informed by data around the needs of the most vulnerable older adults.”

The new study uses 2021 data and builds on NORC’s landmark Forgotten Middle study, which the organization updated in August of 2022.

The study found that only a small segment of near-duals transitioned to full dual-eligible status between 2017 through 2020, which creates a vulnerable population that will have “limited options” for seeking long-term care unless “robust and timely policy reforms” are enacted nationwide.

The study also tasked housing, long-term care and aging experts with devising policy solutions to create affordable, equitable and accessible aging services for middle-income older adults.

The researchers identified four strategies for doing so: Developing a new Home and Community-Based Services (HCBS) benefit to provide needs-based coverage in Medicare and expanding eligibility for Medicaid. The researchers also called for increasing funding for home repair and modification programs and programs that directly support older adults in need.

“Nearly 7 million older adults live in a perilous financial situation, which can be hazardous to not just finances, but health care and access, too,” said Narda Ipakchi, vice president of policy at The SCAN Foundation. “Real policy change and relief for Near Duals is urgently needed so they can receive the necessary long-term care needed to age in their homes, safely and surrounded by community.”

NORC will hold a webinar later this month on Oct. 25 to discuss the issue and its solutions.