Recent Health Care Use and Medicaid Entry of Medicare Beneficiaries

Abstract

Purpose of the study: To examine the relationship between Medicaid entry and recent health care use among Medicare beneficiaries.

Design and methods: We identified Medicare beneficiaries without full Medicaid or use of hospital or nursing home services in 2008 (N = 2,163,387). A discrete survival analysis estimated beneficiaries' monthly likelihood of entry into the full Medicaid program between January 2009 and June 2010.

Results: During the 18-month study period, Medicaid entry occurred for 1.1% and 3.7% of beneficiaries who aged into Medicare or originally qualified for Medicare due to disability, respectively. Among beneficiaries who aged into Medicare, 49% of new Medicaid participants had no use of inpatient, skilled nursing facility, or nursing home services during the study period. Individuals who recently used inpatient, skilled nursing facility or nursing home services had monthly rates of 1.9, 14.0, and 38.1 new Medicaid participants per 1,000 beneficiaries, respectively, compared with 0.4 new Medicaid participants per 1,000 beneficiaries with no recent use of these services.

Implications: Although recent health care use predicted greater likelihood of Medicaid entry, half of new Medicaid participants used no hospital or nursing home care during the study period. These patterns should be considered when designing and evaluating interventions to reform health care delivery for dual-eligible beneficiaries.

Keywords: Dual-eligible beneficiaries; Hospitalizations; Long-term care.

Figure 1.

Distribution of any use of hospital, skilled nursing facility, or nursing home services by Medicaid entry status and original reason for Medicare eligibility. Results are based on authors’ analysis of Medicare enrollment and claims data. Percentages are weighted by the number of months beneficiaries were observed before Medicaid entry or the end of the study. Graphs exclude beneficiaries who exited study due to death.

Figure 2.

Adjusted monthly rate of medicaid entry among Medicare beneficiaries, by Medicare eligibility group and recent use of hospital, skilled nursing facility, or nursing home services. Adjusted for age, race, sex, prescription drug coverage, receipt of Part D low-income subsidy or partial Medicaid, total number of inpatient and SNF days, total number of months with nursing home use, estimated percent with no supplemental coverage, area-level socioeconomic quintile, state, observation month. Dashed lines indicate 95% confidence intervals.