Association Of State Policies With Medicaid Disenrollment Among Low-Income Medicare Beneficiaries

Association Of State Policies With Medicaid Disenrollment Among Low-Income Medicare Beneficiaries
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DOI：
10.1377/hlthaff.2018.05165
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发表时间：
2019-07-01
期刊：
HEALTH AFFAIRS
影响因子：
9.7
通讯作者：
Sabik, Lindsay M.
Sabik, Lindsay M.
中科院分区：
医学1区
文献类型：
--
作者：
Roberts, Eric T.;Welsh, Jacqueline Hayley;Sabik, Lindsay M.

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对于一些低收入的联邦医疗保险受益人，联邦医疗补助提供了针对联邦医疗保险自付费用的财务保护，但许多有资格获得联邦医疗补助的联邦医疗保险受益人并没有连续参加。我们调查了按服务收费的医疗保险受益人中的医疗补助退保情况，以及退保和州政策之间的关系。在2012-16年间，18.2%接受全部或部分医疗补助的联邦医疗保险受益人因死亡以外的原因退出保险。超过50%的联邦医疗保险受益人在退保一年后仍未获得联邦医疗补助，他们继续获得联邦医疗保险D部分保险的低收入补贴，资格要求与联邦医疗补助相似。在持续提供D部分补贴的联邦医疗保险受益人中，自动将联邦补充保障收入计划的接受者纳入全额医疗补助的州的联邦医疗补助退保率降低了24%，提供者支付政策更慷慨的州降低了33%，部分医疗补助的资产限制较少的州降低了37%。那些使人们更容易保持医疗补助资格的政策，以及通过更高的提供者报销来增强医疗补助中的护理机会的政策，可能会减少退保。
For some low-income Medicare beneficiaries, Medicaid provides financial protection against Medicare's out-of-pocket costs, but many Medicare beneficiaries who qualify for Medicaid are not continuously enrolled. We examined Medicaid disenrollment among fee-for-service Medicare beneficiaries and the relationship between disenrollment and state policies. In the period 2012-16, 18.2 percent of Medicare beneficiaries who received full or partial Medicaid disenrolled for reasons other than death. More than 50 percent of Medicare beneficiaries who remained without Medicaid one year after disenrolling continued to receive low-income subsidies for Medicare Part D coverage with eligibility requirements similar to those of Medicaid. Among Medicare beneficiaries with continuous Part D subsidies, the rate of Medicaid disenrollment was 24 percent lower in states that automatically enrolled recipients of the federal Supplemental Security Income program in full Medicaid, 33 percent lower in states with more generous provider payment policies, and 37 percent lower in states with less restrictive asset limits for partial Medicaid. Policies that make it easier for people to maintain Medicaid eligibility and that enhance access to care in Medicaid via higher provider reimbursements may reduce disenrollment.