Beyond Spend-down: The Prevalence and Process of Transitions to Medicaid. Policy context of study


  • Dually eligible Medicare enrollees are disproportionately costly for Medicaid
    • Minority of Medicaid enrollees
    • High costs primarily owing to need for long term services and supports
  • Policy concerns are two-fold
    • Some believe asset transfer to gain eligibility is widespread in the middle class
    • Others believe more accessible prefunding options could reduce need for “spend-down” to eligibility
  • Both suggest a need for updated analyses of the rate and process of transitions to Medicaid

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