Loss of Medicare-Medicaid Dual Eligible Status: Frequency, Contributing Factors and Implications

05/09/2019

This paper seeks to document the frequency of Medicaid coverage loss among full-benefit dual eligible beneficiaries and identify potential causes for coverage loss. For dual eligible beneficiaries, the loss of full-benefit Medicaid coverage is of concern because most of them do not have an alternative source of health insurance for the services covered by full-benefit Medicaid. For providers involved in the care of dual eligible beneficiaries, discontinuity in full-benefit Medicaid coverage may lead to disruption in care and adverse health outcomes.

There is wide variation in the rates of full-benefit Medicaid coverage loss across states, driven in part by state Medicaid eligibility policies. New full duals in 209(b) states, or in states that apply the special income rule were more likely to lose coverage than those in states without such policies, while individuals in states that provide poverty-level coverage had lower risk of losing coverage. Findings suggest that states with relatively more inclusive Medicaid eligibility coverage policies (which may have more streamlined recertification and other procedural requirements) tend to decrease coverage loss than states with relatively more restrictive Medicaid coverage.

High "churning" in dual eligible status is problematic for both individual beneficiaries and providers. For dual eligible beneficiaries, the loss of full-benefit Medicaid coverage is of concern because most of them do not have an alternative source of health insurance for the services covered by full-benefit Medicaid. Without Medicaid support, many of these low-income individuals may have difficulty paying for cost-sharing of Medicare services and may be unable to access services that are not covered by Medicare (such as long-term services and supports). For providers involved in the care of dual eligible beneficiaries, discontinuity in full-benefit Medicaid coverage may lead to financial losses.

This report was prepared under contract #HHSP233201600021I between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the Research Triangle Institute. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/office-disability-aging-and-long-term-care-policy-daltcp or contact the ASPE Project Officer, Jhamirah Howard, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201; Jhamirah.Howard@hhs.gov.

DISCLAIMER: The opinions and views expressed in this report are those of the authors. They do not reflect the views of the Department of Health and Human Services, the contractor or any other funding organization. This report was completed and submitted on September 2017.

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