Understanding Factors Associated With Loss Of Medicaid Coverage Among Dual Eligibles Can Help Identify Vulnerable Enrollees
Understanding Factors Associated With Loss Of Medicaid Coverage Among Dual Eligibles Can Help Identify Vulnerable Enrollees
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DOI：
10.1377/hlthaff.2013.0396
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发表时间：
2014-01-01
期刊：
影响因子：
9.7
通讯作者：
Tilahun, Negussie
中科院分区：
文献类型：
--
作者：
Riley, Gerald F.;Zhao, Lirong;Tilahun, Negussie
对于同时享受 Medicare 和 Medicaid 福利的人（双重资格受益人）来说，失去 Medicaid 覆盖范围可能会导致护理协调问题、自付费用增加或获得服务的机会减少。使用行政数据，我们从 2009 年 1 月到 2011 年 12 月对 292,242 名全额福利和 91,020 名部分福利双重资格受益人进行了跟踪。在那些享有全额医疗补助福利的人中，15.6% 的人至少失去过一次医疗补助保险，其中年轻受益人更频繁地失去医疗补助。其中许多损失只持续了一到三个月，随后又恢复了。在享受部分医疗补助福利的参保者中，失去医疗补助覆盖范围更为常见（23.2%）。医疗保险当前受益人调查数据表明，大多数失去医疗补助保险的双重资格者没有其他补充保险来源。双重资格者的医疗补助覆盖范围相对稳定。然而，一些人失去医疗补助几个月或更长时间，使他们面临结果不佳的风险，并可能使他们的护理变得复杂，特别是当需要将其整合到两个计划下时。
For people who receive both Medicare and Medicaid benefits (dual-eligible beneficiaries), the loss of Medicaid coverage may lead to problems with care coordination, higher out-of-pocket expenses, or reduced access to services. Using administrative data, we followed 292,242 full-benefit and 91,020 partial-benefit dual eligibles from January 2009 through December 2011. Among those with full Medicaid benefits, 15.6 percent lost Medicaid coverage at least once, with more frequent losses among younger beneficiaries. Many of these losses lasted only one to three months and were followed by reinstatement. Loss of Medicaid coverage was more common (23.2 percent) among enrollees with partial Medicaid benefits. Medicare Current Beneficiary Survey data indicate that most dual eligibles who lost Medicaid coverage had no other source of supplemental insurance. Medicaid coverage is relatively stable among dual eligibles. However, some lose Medicaid for several months or more, putting them at risk for poor outcomes and potentially complicating their care, especially when it needs to be integrated under the two programs.