Nursing Home

Non-Elderly Disabled Category 2 Housing Choice Voucher Program: An Implementation and Impact Analysis. Executive Summary

The Housing Choice Voucher (HCV) program for institutionalized, non-elderly disabled (NED) people stems from the 1999 case Olmstead v. L.C. (527 U.S. 581), in which the U.S. Supreme Court declared that people with disabilities are entitled to receive services in "the most integrated setting appropriate." This ruling required states to expand optio

Non-Elderly Disabled Category 2 Housing Choice Voucher Program: An Implementation and Impact Analysis. Acronyms

The following acronyms are mentioned in this report and/or appendices.

Non-Elderly Disabled Category 2 Housing Choice Voucher Program: An Implementation and Impact Analysis. Abstract

Background : The U.S. Department of Housing and Urban Development (HUD), in collaboration with the Centers for Medicare and Medicaid Services, allocated Housing Choice Vouchers to 28 public housing authorities (PHAs) in January 2011. PHAs were required to partner with the state Money Follows the Person program, or the relevant health and human se

Non-Elderly Disabled Category 2 Housing Choice Voucher Program: An Implementation and Impact Analysis. Acknowledgments

The authors acknowledge the efforts of the many people who helped produce this report. First, thanks to Hakan Aykan, Alison Cuellar and Gavin Kennedy in the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services, for providing overall direction and support for this study.

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

These beneficiaries are also commonly called dual eligible. 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.

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

The following tables contain the set of coefficient estimates and odds ratios from the regression models. To get predicted rates for Table 2 and Table 3 , we retained the estimated coefficients. Then for "No ER Visit Resulting in IP Stay, SNF Stay, or Other NH Stay", we computed the predicted transition rate by setting the indicator variables f

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

Bharucha, A., R. Pandav, C. Shen, H.H. Dodge, and M. Ganguli. "Predictors of Nursing Facility Admission: A 12-Year Epidemiological Study in the United States." Journal of the American Geriatrics Society , 52(3): 434-439, March 2004.

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.

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

Some limitations of this study should be noted in considering our results. First, our analysis was restricted to those not in managed care, and understanding how transition rates differ for those in managed care may be informative and policy relevant. Second, our results are informative of factors that predict MME status and nursing home entry, bu

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

This analysis identified nursing home use (SNF or other nursing home) as an important predictor of MME status, particularly among younger Medicare beneficiaries. Additionally, having both a Medicare-financed SNF stay and a non-SNF stay is an even stronger predictor of MME status. Chronic conditions, particularly related to Alzheimer's or dementia,

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

In addition to service utilization, chronic conditions were also associated with the rate of transition to MME status, as well as non-SNF nursing home entry.

Factors Predicting Transitions from Medicare-Only to Medicare-Medicaid Enrollee Status. Nursing Home Entry and Service Utilization

The results in the previous section highlight that a nursing home stay, particularly a non-SNF stay, is strongly predictive of transition to MME status. The analysis indicates that acute care services and SNF use are associated with having a non-SNF nursing home stay ( Table 3 ). For those under 65 with "no prior ER visit resulting in an inpatient

Factors Predicting Transitions from Medicare-Only to Medicare-Medicaid Enrollee Status. Transitions to Dual Eligibility and Service Utilization

The analysis indicates that the likelihood that Medicare beneficiaries transition to MME status is associated with the types of services they use, particularly nursing home care ( Table 2 ). For example, among younger Medicare-only beneficiaries with no service utilization--"no ER visit leading to an inpatient admission, no SNF stay, and no non-SN

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

Factors Predicting Transitions from Medicare-Only to Medicare-Medicaid Enrollee Status. Data and Methodology

We combined data from multiple sources to examine beneficiary characteristics and service utilization patterns that predict transitions from Medicare-only eligibility to MME status on a monthly basis. We also examined beneficiary characteristics and service utilization patterns that predict entry into nursing home care not covered by the Medicare

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

MMEs must meet the eligibility requirements of both Medicare and Medicaid. At a high level, Medicare beneficiaries become eligible for Medicaid through one of three ways: having low income and few resources, incurring high medical expenses, or requiring institutional level of care (for a more complete description, see the companion study by Borck

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

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

The following acronyms are mentioned in this report and/or appendix.

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

Objective . 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, a significant predictor of dual eligibility for Medicare and Medicaid coverage. Key Outcomes . We estimate the probability of transitioning to dual eligibility for

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

This study focuses on understanding the rates and patterns of enrollment in Medicaid among individuals already enrolled in Medicare, the factors that predict this transition to dual coverage, and those that predict nursing home entry. This volume provides estimated econometric models that predict beneficiaries’ enrollment in Medicaid, and thei

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