Factors Predicting Transitions from Medicare-Only to Medicare-Medicaid Enrollee Status. Introduction


Medicare-Medicaid enrollees (MMEs) are older adults and individuals with disabilities who qualify for both Medicare and Medicaid coverage.1 They are among the most vulnerable people served by Medicare and Medicaid, with half of MMEs having incomes below the federal poverty line, compared to about 8 percent of Medicare beneficiaries who are not dually eligible (CMS 2011). They are also among the costliest users of health care (MedPAC 2011), with average Medicare spending nearly double that of other Medicare beneficiaries (Jacobson et al. 2012).

The purpose of this report is to gain a better understanding of the factors associated with Medicaid enrollment among Medicare beneficiaries as well as the factors associated with nursing home entry, which we find to be a significant predictor of MME status. Understanding these factors may shed light on policy interventions designed to prevent at least some types of impoverishment that would precipitate Medicaid eligibility, ensure that the needs of beneficiaries are adequately met, and support the sustainability of long-term care (LTC) systems.


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