There Is Little Experience And Limited Data To Support Policy Making On Integrated Care For Dual Eligibles

Gold, Marsha; Jacobson, Gretchen; Garfield, Rachel

doi:10.1377/hlthaff.2012.0162

Cited by 38 publications

(38 citation statements)

References 3 publications

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“…However, the data are mainly descriptive and do not account for the role of casemix or other characteristics. One explanation for disproportionate costs is that double program coverage results in overlaps and inefficiencies, leading to proposed solutions such as integrated care (Gold, Jacobson, & Garfield, 2012;Meyer, 2012;Neuman, Lyons, Rentas, & Rowland, 2012). There is a clear need to identify the specific characteristics of Medicare-Medicaid enrollees that account for their disproportionately high expenditures for medical and long-term care.…”

Section: Me D I C a R E -Me D I C A I D E N R O L L E E S A R E A Hetmentioning

confidence: 99%

Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

Kane¹,

Wysocki²,

Parashuram³

et al. 2013

MMRR

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Results: Among dual eligibles and non-dual eligibles, the average number of diseases and case mix scores are higher for LTC users. Adjusting for case mix virtually eliminates the difference for medical costs, but not for LTC expenditures. Adjusting for LTC status reduces the difference in LTC costs, but increases the difference in medical costs. Conclusions:Efforts to control costs for dual eligibles should target those in LTC while better coordinating medical and LTC expenditures. Access, Demand Uninsured, 2011Uninsured, , 2012 Kane, Homyak, Parashuram, Lee, & Woodhouse, 2008; Kasper, Watts, & Lyons, 2010; Young, Garfield, Musumeci, Clemens-Cope, Lawton, 2012). However, the data are mainly descriptive and do not account for the role of casemix or other characteristics. One explanation for disproportionate costs is that double program coverage results in overlaps and inefficiencies, leading to proposed solutions such as integrated care (Gold, Jacobson, & Garfield, 2012;Meyer, 2012;Neuman, Lyons, Rentas, & Rowland, 2012). There is a clear need to identify the specific characteristics of Medicare-Medicaid enrollees that account for their disproportionately high expenditures for medical and long-term care. Keywords:The only study to examine the effect of casemix on Medicare-Medicaid enrollees' higher LTC costs found that they were largely attributable to greater levels of dysfunction and disease burden (Liu, Long, & Aragon, 1998). Our study builds upon this work with more recent data and a separate examination of the role of LTC care setting and case mix for elderly MedicaidMedicare beneficiaries. We analyzed Medicare and Medicaid data to examine how type of long-term care and case mix affect expenditures towards medical care and LTC for older MedicareMedicaid enrollees and non-duals, and how these expenditures vary between programs and settings. In response to the findings of Bubolz, Emerson, and Skinner (2012), we also looked for evidence of de facto cross-subsidization among those covered by both Medicare and Medicaid; namely, was nursing home use (covered only by Medicaid) associated with lower medical care use (covered by Medicare)? Methods Study PopulationOur study population consists of individuals aged 65 years and older in 2005, enrolled in (1) Medicaid only, (2) Medicare only, and (3) Medicare and Medicaid simultaneously. We selected residents from seven states (Arkansas, Florida, Minnesota, New Mexico, Texas, Vermont, and Washington) who illustrate diverse management techniques across the target populations, and diverse state characteristics; e.g., demographics, size, geography, structure of county government, and policies. The LTC waiver, state plan programs, and plan variations are summarized in Appendix Exhibit A1. All of the states had an aging and disability waiver.In order to analyze the characteristics and expenditures of duals and non-dual beneficiaries based on LTC utilization, we classified our study sample into four groups based on program enrollment and LTC use: MMRR 2013: Volume 3 ...

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Section: Me D I C a R E -Me D I C A I D E N R O L L E E S A R E A Hetmentioning

confidence: 99%

Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

Kane¹,

Wysocki²,

Parashuram³

et al. 2013

MMRR

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“…A lack of clinical integration of acute and long-term care has led to inefficiencies and lower quality of care. 6 And a lack of financial integration of payments under Medicare and Medicaid has produced conflicting program incentives and cost shifting that might raise overall costs. 7 Differences in Medicare and Medicaid administrative structures have created barriers to improvement.…”

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confidence: 99%

Understanding Factors Associated With Loss Of Medicaid Coverage Among Dual Eligibles Can Help Identify Vulnerable Enrollees

2014

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“…Although states' projects must meet overall CMS guidelines, states may establish their own requirements for MCOs. MCOs typically have little experience providing LTSS (Gold, Jacobson, & Garfield, 2012), and this change may result in reduced access to HCBS as well as limited data reporting on policies, participants, and expenditures. Since existing state policies for home health, state plan personal care, and 1915(c) waiver programs probably may not apply to MCOs, future research should study what policies are adopted for MCOs and how these impact the provision of HCBS.…”

Section: Discussionmentioning

confidence: 99%

Medicaid Home and Community-Based Services: How Consumer Access Is Restricted by State Policies

Stone

Harrington

2015

Journal of Aging & Social Policy

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State Medicaid programs have expanded home and community-based services (HCBS). This article compares trends and variations in state policies for Medicaid HCBS programs in 2005 and 2010. State limitations on financial eligibility criteria and service benefits have remained stable. Although the use of consumer direction, independent providers, and family care providers has increased, some states do not have these options. The increased adoption of state cost control policies have led to large increases in persons on waiver wait lists. Access could be improved by standardizing and liberalizing state HCBS policies, but state fiscal concerns are barriers to rebalancing between HCBS and institutional services.

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There Is Little Experience And Limited Data To Support Policy Making On Integrated Care For Dual Eligibles

Cited by 38 publications

References 3 publications

Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

Understanding Factors Associated With Loss Of Medicaid Coverage Among Dual Eligibles Can Help Identify Vulnerable Enrollees

Medicaid Home and Community-Based Services: How Consumer Access Is Restricted by State Policies

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