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

01/01/2014

  1. These beneficiaries are also commonly called dual eligible.

  2. See Borck et al. (2013) or Kaiser Family Foundation (2010) for additional information about Medicaid-eligibility for individuals who are aged or have a disability.

  3. Transitions from Medicaid-only coverage to MME status typically occur when someone turns 65 or when a younger Medicaid enrollee who has qualified for disability insurance satisfies the two-year waiting period required to be eligible for Medicare.

  4. We wanted to focus the study on adults to eliminate some of the complexities associated with the differences in Medicaid-eligibility rules between children and adults. Some Medicaid-eligibility policies consider beneficiaries under the age of 21 as children. To establish a sample that would be uniformly treated as adults across all categories of Medicaid beneficiaries, we selected age 22 as the cut off for this study.

  5. Inclusion of the ESRD subgroup would have required obtaining information from additional data sources and it was not clear that the benefits of including this group would outweigh the additional costs of analyzing them. Nevertheless, the exclusion of this group suggests further research work will be necessary to understand whether this group has more or less similar rates of transitions into Medicare-Medicaid enrollment or long-term nursing home care.

  6. Analyzing January 2009 transitions would have required 2008 MBSF data to determine eligibility status in December 2008. Assuming that January transitions were not likely to substantially differ from transitions in other months, we sought to avoid bringing in the 2008 MBSF data and any associated linking issues.

  7. In our regression analyses, we weight observations from the Medicare 5 percent sample by 20 to account for sampling and to obtain estimates that reflect population rates.

    In the dataset, we observe any given individual for up to 11 months (February to December), which means that we have multiple observations for a single individual. Because these multiple observations of the same individual are not independent, our standard error estimates, which are based on the assumption of independence, are biased downward. However, because of the very large sample sizes for this analysis, this bias is small and unlikely to be consequential for interpreting the results.

  8. We also estimated models where we included variables for specific state characteristics instead of state fixed effects, to determine whether any were predictive. These variables included the percent of the population age 65 and over; an indicator for medically needy programs; an indicator for poverty-related expansions; and an indicator for expanded Medicaid-eligibility for individuals needing institutional levels of care. Results were mixed, however. For example, we found that older Medicare beneficiaries who lived in states with a medically need program were more likely to become dually eligible but younger beneficiaries in the same states were less likely to do so. It is possible that these indicators may reflect other state characteristics not captured in our models, but that are correlated with them. Without data to utilize year-to-year variation in these indicators, it is difficult to disentangle these correlations.

  9. Borck et al. (2012) find that enrollees under age 65 have higher transition rates than those age 65 and above (as well as account for a disproportionate share of new MMEs).

  10. Note that while the service utilization patterns studied here are for the most part more prevalent among older than younger beneficiaries (Table 1), it still remains the case that, conditional on experiencing these events, the likelihood of transitioning is higher among younger beneficiaries than older beneficiaries.

  11. Note that these odds ratios mask the fact that because the underlying transition rate is much higher among younger beneficiaries, the magnitude of the difference in the MME transition rate due to dementia is actually higher among younger beneficiaries than older beneficiaries.


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Association between NCQA Patient-Centered Medical Home Recognition for Primary Care Practices and Quality of Care for Children with Disabilities and Special Health Care Needs
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Children with Disabilities and Special Health Care Needs in NCQA-Recognized Patient-Centered Medical Homes: Health Care Utilization, Provider Perspectives and Parental Expectations Executive Summary
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Descriptive Study of Three Disability Competent Managed Care Plans for Medicaid Enrollees
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Effect of PACE on Costs, Nursing Home Admissions, and Mortality: 2006-2011
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Effectiveness of Alternative Ways of Implementing Care Management Components in Medicare D-SNPs: The Brand New Day Study
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Effectiveness of Alternative Ways of Implementing Care Management Components in Medicare D-SNPs: The Care Wisconsin and Gateway Study
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Evaluating PACE: A Review of the Literature
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Factors Predicting Transitions from Medicare-Only to Medicare-Medicaid Enrollee Status
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Identifying Medicare Beneficiaries with Disabilities: Improving on Claims-Based Algorithms
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Impacts of Waiting Periods for Home and Community-Based Services on Consumers and Medicaid Long-Term Care Costs in Iowa
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Integrating Physical Health Care in Behavioral Health Agencies in Rural Pennsylvania
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Non-Elderly Disabled Category 2 Housing Choice Voucher Program: An Implementation and Impact Analysis
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Parent Perspectives on Care Received at Patient-Centered Medical Homes for Their Children with Special Health Care Needs
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Strategies for Integrating and Coordinating Care for Behavioral Health Populations: Case Studies of Four States
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Transitions from Medicare-Only to Medicare-Medicaid Enrollment
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