States With Medically Needy Pathways: Differences in Long-Term and Temporary Medicaid Entry for Low-Income Medicare Beneficiaries

Abstract

Medically needy pathways may provide temporary catastrophic coverage for low-income Medicare beneficiaries who do not otherwise qualify for full Medicaid benefits. Between January 2009 and June 2010, states with medically needy pathways had a higher percentage of low-income beneficiaries join Medicaid than states without such programs (7.5% vs. 4.1%, p < .01). However, among new full Medicaid participants, living in a state with a medically needy pathway was associated with a 3.8 percentage point (adjusted 95% confidence interval [1.8, 5.8]) increase in the probability of switching to partial Medicaid and a 4.5 percentage point (adjusted 95% confidence interval [2.9, 6.2]) increase in the probability of exiting Medicaid within 12 months. The predicted risk of leaving Medicaid was greatest when new Medicaid participants used only hospital services, rather than nursing home services, in their first month of Medicaid benefits. Alternative strategies for protecting low-income Medicare beneficiaries’ access to care could provide more stable coverage.

Keywords

Medicare Medicaid dual-eligible beneficiaries state policy low-income populations

Get full access to this article

View all access options for this article.

References

Adams

E. K.

Meiners

M. R.

Burwell

B. O.

(1993). Asset spend-down in nursing homes: Methods and insights. Medical Care, 31, 1-23.

Allison

P. D.

(2010). Survival analysis using SAS: a practical guide (2nd ed.). Cary, NC: SAS Institute.

Bhattacharya

Goldman

Sood

(2003). The link between public and private insurance and HIV-related mortality. Journal of Health Economics, 22, 1105-1122.

Bindman

A. B.

Chattopadhyay

Auerback

G. M.

(2008). Interruptions in Medicaid coverage and risk for hospitalization for ambulatory care-sensitive conditions. Annals of Internal Medicine, 149, 854-860.

Blumenthal

Davis

Guterman

(2015). Medicare at 50: Moving forward. New England Journal of Medicine, 372, 671-677.

Bonito

A. J.

Bann

Eicheldinger

Carpenter

(2008). Chapter 3: Creating and validating an index of socioeconomic status; creation of new race-ethnicity codes and socioeconomic status (SES) indicators for Medicare beneficiaries. Retrieved from http://archive.ahrq.gov/research/findings/final-reports/medicareindicators/medicareindicators3.html

Borck

Irvin

C. V.

Lim

(2014). Transitions from Medicare-only to Medicare-Medicaid enrollment. Retrieved from http://aspe.hhs.gov/daltcp/reports/2014/MMTransV1.pdf

Briesacher

B. A.

Ross-Degnan

Wagner

A. K.

Fouayzi

Zhang

Gurwitz

J. H.

Soumerai

S. B.

(2010). Out-of-pocket burden of health care spending and the adequacy of the Medicare Part D low-income subsidy. Medical Care, 48, 503-509.

Carpenter

(1998). Evolution of Medicaid coverage of Medicare cost sharing. Health Care Financing Review, 20(2), 11-18.

10.

CMS Chronic Condition Data Warehouse. (2016). Table F.1: Medicare Part D Beneficiary Counts for 2006 Through 2014. Retrieved from https://www.ccwdata.org/documents/10280/19096644/ccw-website-table-f1.pdf

11.

Cubanski

Swoope

Damico

Neuman

(2014). How much is enough? Out-of-pocket spending among Medicare beneficiaries: A chartbook. Retrieved from http://files.kff.org/attachment/how-much-is-enough-out-of-pocket-spending-among-medicare-beneficiaries-a-chartbook-report

12.

De Nardi

French

Jones

J. B.

Gooptu

. (2011). Medicaid and the elderly (NBER Working Paper No. 17689). Retrieved from http://www.nber.org/papers/w17689

13.

Dorn

Shang

(2012). Spurring enrollment in Medicare Savings Programs through a substitute for the asset test focused on investment income. Health Affairs, 31, 367-375.

14.

Ettner

S. L.

(1997). Medicaid participation among the eligible elderly. Journal of Policy Analysis and Management, 16, 237-255.

15.

Feder

Moon

Scanlon

(1987). Medicare reform: Nibbling at catastrophic costs. Health Affairs, 6(4), 5-19.

16.

Federman

A. D.

Vladeck

B. C.

Siu

A. L.

(2005). Avoidance of health care services because of cost: Impact of the Medicare Savings Program. Health Affairs, 24, 263-270.

17.

Government Accountability Office. (2012). Medicare savings programs: Implementation of requirements aimed at increasing enrollment. Retrieved from http://www.gao.gov/assets/650/648370.pdf

18.

Haber

S. G.

Adamache

Walsh

E. G.

Hoover

Bir

Caswell

. . . Smith

(2003). Evaluation of Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) programs. Retrieved from https://www.cms.gov/reports/downloads/HaberVol1.pdf

19.

Hall

A. G.

Harman

J. S.

Zhang

(2008). Lapses in Medicaid coverage: Impact on cost and utilization among individuals with diabetes enrolled in Medicaid. Medical Care, 46, 1219-1225.

20.

Kaiser Commission on Medicaid and the Uninsured. (2010). Medicaid financial eligibility: Primary pathways for the elderly and people with disabilities. Retrieved from http://www.kff.org/medicaid/upload/8048.pdf

21.

Keohane

L. M.

Trivedi

A. N.

Mor

(2017). Recent health care use and Medicaid entry of Medicare beneficiaries. Gerontologist, 57, 977-986. doi:10.1093/geront/gnw189

22.

Konetzka

R. T.

Karon

S. L.

Potter

D. E. B.

(2012). Users of Medicaid home and community-based services are especially vulnerable to costly avoidable hospital admissions. Health Affairs, 31, 1167-1175.

23.

Lakdawalla

Sood

Goldman

(2006). HIV breakthroughs and risky sexual behavior. Quarterly Journal of Economics, 121, 1063-1102.

24.

Lim

Irvin

C. V.

Borck

(2014). Factors predicting transitions from Medicare-only to Medicare-Medicaid enrollee status. Retrieved from http://aspe.hhs.gov/daltcp/reports/2014/MMTransV2.pdf

25.

Liu

Manton

K. G.

(1989). The effect of nursing home use on Medicaid eligibility. Retrieved from http://aspe.hhs.gov/daltcp/reports/1989/nhumedes.htm

26.

Medicaid and CHIP Payment and Access Commission. (2013). Chapter 4: Medicaid coverage of premiums and cost sharing for low-income Medicare beneficiaries. Retrieved from https://www.macpac.gov/wp-content/uploads/2015/01/Medicaid_Coverage_of_Premiums_and_Cost_Sharing_for_Low-Income_Medicare_Beneficiaries.pdf

27.

Medicare Payment Advisory Commission. (2008). Chapter 5: Increasing participation in the Medicare Savings Programs and the low-income drug subsidy. Retrieved from http://medpac.gov/docs/default-source/reports/Mar08_Ch05.pdf

28.

Medicare Payment Advisory Commission. (2016). Chapter 9: Issues affecting dual-eligible beneficiaries: CMS’s financial alignment demonstration and the Medicare Savings Programs. Retrieved from http://www.medpac.gov/docs/default-source/reports/chapter-9-issues-affecting-dual-eligible-beneficiaries-cms-s-financial-alignment-demonstration-and-t.pdf

29.

Medicare Payment Advisory Commission and Medicaid and CHIP Payment Access Commission. (2016). Data book: Beneficiaries dually eligible for Medicare and Medicaid. Retrieved from https://www.macpac.gov/wp-content/uploads/2015/01/Dually-Eligible-Beneficiares-DataBook.pdf

30.

Moon

Brennan

Segal

(1998). Options for aiding low-income Medicare beneficiaries. Inquiry, 35, 346-356.

31.

Musumeci

(2014). Financial and administrative alignment demonstrations for dual eligible beneficiaries compared: States with memoranda of understanding approved by CMS. Retrieved from http://kaiserfamilyfoundation.files.wordpress.com/2014/07/8426-06-financial-alignment-demonstrations-for-dual-eligible-beneficiaries-compared.pdf

32.

Nardi

M. D.

French

Jones

J. B.

McCauley

(2015). Medical spending of the U.S. elderly (NBER Working Paper No. 21270). Retrieved from http://www.nber.org/papers/w21270

33.

Nemore

P. B.

Bender

J. A.

Kwok

W.-W.

(2006). Toward making Medicare work for low-income beneficiaries: A baseline comparison of the Part D Low-Income Subsidy and Medicare Savings Programs eligibility and enrollment rules. Retrieved from https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7519.pdf

34.

Osborn

Moulds

Squires

Doty

M. M.

Anderson

(2014). International survey of older adults finds shortcomings in access, coordination, and patient-centered care. Health Affairs, 33, 2247-2255.

35.

Perry

Kannel

Dulio

(2002). Barriers to Medicaid enrollment for low-income seniors: Focus group findings. Retrieved from http://www.kff.org/medicaid/4029-index.cfm

36.

Pezzin

L. E.

Kasper

J. D.

(2002). Medicaid enrollment among elderly Medicare beneficiaries: individual determinants, effects of state policy, and impact on service use. Health Services Research, 37, 827-847.

37.

Riley

G. F.

(2007). Long-term trends in the concentration of Medicare spending. Health Affairs, 26, 808-816.

38.

Riley

G. F.

Zhao

Tilahun

(2014). Understanding factors associated with loss of Medicaid coverage among dual eligibles can help identify vulnerable enrollees. Health Affairs, 33, 147-152.

39.

Singer

J. D.

Willett

J. B.

(2003). Applied longitudinal data analysis: Modeling change and event occurrence. New York, NY: Oxford University Press.

40.

Social Security Administration. (2016). Program operations manual system HI 03030.025: Resource limits for subsidy eligibility. Retrieved from https://secure.ssa.gov/poms.nsf/lnx/0603030025

41.

Ungaro

Federman

A. D.

(2009). Restrictiveness of eligibility determination and Medicaid enrollment by low-income seniors. Journal of Aging & Social Policy, 21, 338-351.

42.

Walker

Accius

(2010). Access to long-term services and supports: A 50-state survey of Medicaid financial eligibility standards. Retrieved from http://assets.aarp.org/rgcenter/ppi/ltc/i44-access-ltss_revised.pdf

43.

Watts

M. O. M.

Young

(2012). The Medicaid medically needy program: Spending and enrollment update. Retrieved from https://kaiserfamilyfoundation.files.wordpress.com/2013/01/4096.pdf

44.

Zerzan

Edlund

Krois

Smith

(2007). The demise of Oregon’s medically needy program: Effects of losing prescription drug coverage. Journal of General Internal Medicine, 22, 847-851.

45.

Zuckerman

Shang

Waidmann

(2009). Medicare savings programs: Analyzing options for expanding eligibility. Inquiry, 46, 391-404.