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


This analysis identified nursing home use and ER visits leading to an inpatient stay as significant predictors of the transition from Medicare-only eligibility to MME status. Moreover, these predictors were particularly strong among younger Medicare beneficiaries (under 65) compared to older (65 and above) beneficiaries. To the extent that nursing home admissions causally affect the transition to Medicaid coverage, then policies and programs that limit admissions to nursing home care or shorten nursing home stays may reduce the rate of transition to MME status among individuals at increased risk for becoming Medicaid eligible. For example, interventions that help people at risk for becoming dually eligible avoid undesirable events such as acute emergencies that lead to an inpatient admission and entry into nursing home care would likely reduce entry into dual eligibility. Such interventions might need to focus on minimizing preventable emergencies (such as those due falls and other types of injuries).

The results also indicate that dementia disorders and depression play important roles in predicting the transition to MME status and entry into nursing home care. Services and care coordination programs may need to be tailored to meet the needs of beneficiaries with these particular conditions. Beneficiaries and their loved ones frequently need assistance in learning how to cope with these conditions.

Many policymakers and other stakeholders advocating for an improved LTC system have focused on nursing home diversion and transition programs. To the extent that these programs reduce nursing home stays, they may also reduce the likelihood of becoming dually eligible. Whether such initiatives and other care innovations are effective at reducing entry into dual eligibility remains to be seen; being able to effectively identify people at risk for long-term nursing home stays appears to be a fruitful first step.

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