State variation in the characteristics of Medicare‐Medicaid dual enrollees: Implications for risk adjustment

Abstract

Objective To examine between‐state differences in the socioeconomic and health characteristics of Medicare beneficiaries dually enrolled in Medicaid, focusing on characteristics not observable to or used by policy makers for risk adjustment. Data Source 2010‐2013 Medicare Current Beneficiary Survey. Study Design Retrospective analyses of survey‐reported health and socioeconomic status (SES) measures among low‐income Medicare beneficiaries and low‐income dual enrollees. We used hierarchical linear regression models with state random effects to estimate the between‐state variation in respondent characteristics and linear models to compare the characteristics of dual enrollees by state Medicaid policies. Principal Findings Between‐state differences in health and socioeconomic risk among low‐income Medicare beneficiaries, as measured by the coefficient of variation, ranged from 17.5 percent for an index of socioeconomic risk to 20.3 percent for an index of health risk. Between‐state differences were comparable among the subset of low‐income beneficiaries dually enrolled in Medicare and Medicaid. Dual enrollees with incomes below the Federal Poverty Level were in better health and had higher SES in states that offered Medicaid to individuals with relatively higher incomes. Duals' average incomes were higher in states with Medically Needy programs. Conclusions Characteristics of dual enrollees differ substantially across states, reflecting differences in states' low‐income Medicare populations and Medicaid policies. Risk‐adjustment methods using dual enrollment to proxy for poor health and low SES should account for this state‐level heterogeneity.

Association of Burden and Prevalence of Arthritis With Disparities in Social Risk Factors, Findings From 17 US States

“…Because as much as 80% of the factors that influence health are outside the traditional health care system, unmet social needs may limit an organization's ability to achieve quality benchmarks associated with value-based payment. Though some health systems are making investments to address social risk factors (27), the aggregate benefit of these investments may not exceed the cost to primary participants in community health, thus limiting the funding needed to address social risks (28). Spreading the cost and the financial benefits of interventions to address social risk shows potential ways to increase uptake among health care systems and managed care organizations (28).…”

“…Though some health systems are making investments to address social risk factors (27), the aggregate benefit of these investments may not exceed the cost to primary participants in community health, thus limiting the funding needed to address social risks (28). Spreading the cost and the financial benefits of interventions to address social risk shows potential ways to increase uptake among health care systems and managed care organizations (28).…”

Association Between Patient Social Risk and Physician Performance Scores in the First Year of the Merit-based Incentive Payment System

“…While many other studies have also done so, dual eligibility may not fully capture patients with social disadvantage, and dual-eligibility criteria vary from state to state. [35][36][37] Second, because this study was cross-sectional, it could not determine whether a causal link exists between patient social risk and MIPS performance, although efforts were made to control for confounders, including medical risk and various practice characteristics. Third, this study focused on the first year of MIPS, the only year for which data are available.…”

Association of Medicare-Medicaid Dual Eligibility and Race and Ethnicity With Ischemic Stroke Severity

“… 9 , 10 , 11 DE is recognized as a proxy for low SES, a social determinant of health. 12 , 13 Despite patients with DE and Black patients having a higher incidence and prevalence of stroke 14 , 15 as well as higher poststroke residual disability 15 than non-DE Medicare beneficiaries, 11 there was previously no information about stroke severity at the time of hospital admission in national Medicare data by race, ethnicity, and SES status. Some evidence suggests initial stroke severity is not associated with race and ethnicity, 16 but to our knowledge, this has not been investigated in a nationally representative population.…”