The Impact of Medicare Hospitalizations and Deductibles on Medicaid Enrollment

描述（由申请人提供）：该国的930万医疗保险-医疗补助双重登记者占所有医疗保险支出的31%和所有医疗补助支出的39%，促使密集的政策努力，以优化护理和减少这一人群的医疗支出。虽然医疗补助计划为医疗保险的重大自付费用提供了基于需求的补充保险，但许多符合条件的医疗保险受益人并没有加入医疗补助计划。发生高医疗相关费用可能会促使低收入个人进入医疗补助。如果是这样的话，降低医疗保险利用率的医疗保险成本分担措施也可能增加医疗补助的注册人数。这种意外的影响将把医疗保险的成本转移到医疗补助上。由于住院自付额很高，对于11%没有补充私人保险来支付费用分摊的医疗保险受益人来说，住院费用可能特别昂贵。本项目研究住院时间及其相关自付费用对医疗保险受益人参加医疗补助的可能性的影响。该研究的假设是，个人将更有可能在住院后参加医疗补助。有较高医院的人 自付费用可能更有可能加入医疗补助计划，这种影响可能因州而异，具体取决于医疗补助资格政策。使用2007-2010年医疗保险索赔和登记数据，本研究将描述医疗保险受益人住院后首次医疗补助登记率在各州之间的变化。时间序列模型将通过人口统计学特征和住院因素（包括诊断、住院时间、慢性病的存在和急性期后护理的出院地点）来表征新的医疗补助计划注册者。一项创新的经济分析将估计额外约1,000美元的医疗保险住院费用分摊对医疗保险受益人参加医疗补助的可能性的影响。医疗保险免赔额要求的外源性变化将用于比较医疗保险受益人之间的医疗保险登记，这些受益人具有相似的医院利用率，但自付费用不同。这项分析的扩展版本将研究居住在允许医疗保险受益人更容易获得医疗补助的州的受益人是否更有可能在产生更大的自付费用后参加医疗补助。研究结果将提供证据，以确定住院和医疗保险费用分摊是否会触发医疗保险受益人参加医疗补助计划。更好地估计受益人对医疗保险成本分摊的反应可能会导致更准确地估计医疗保险成本分摊条款的改革是否会增加或减少医疗补助计划的注册和相关成本。随着各州和医疗保险和医疗补助服务中心为双重登记者设计综合计划，这些研究结果也将为有效护理提供信息 协调新加入医疗补助计划的医疗保险受益人。

DESCRIPTION (provided by applicant): The country's 9.3 million Medicare-Medicaid dual enrollees account for 31% of all Medicare spending and 39% of all Medicaid spending, prompting intensive policy efforts to optimize care and reduce health expenditures for this population. Although Medicaid provides needs-based supplemental coverage for Medicare's significant out-of-pocket costs, many eligible Medicare beneficiaries do not join Medicaid. Incurring high Medicare-related expenses may prompt low-income individuals to enter Medicaid. If so, Medicare cost- sharing measures that reduce Medicare utilization may also increase Medicaid enrollment. This unintended effect would shift Medicare costs to Medicaid. Due to a high inpatient deductible, hospital stays can be particularly expensive for the 11% of Medicare beneficiaries that have no supplemental private insurance to cover cost-sharing. This project examines the impact of a hospital stay and its related out-of-pocket costs on the likelihood of a Medicare beneficiary enrolling in Medicaid. The study's hypothesis is that individuals will be more likely to enroll in Medicaid following a hospitalization. Individuals who have higher hospital out-of-pocket costs could be even more likely to enroll in Medicaid, an effect that could vary across states depending on Medicaid eligibility policies. Using 2007-2010 Medicare claims and enrollment data, this study will describe the variation across states in first-time Medicaid enrollment rates following a hospital admission among Medicare beneficiaries. Time-series models will characterize new Medicaid enrollees by demographic characteristics and inpatient factors including diagnosis, length of stay, presence of chronic conditions and discharge location for post-acute care. An innovative economic analysis will estimate the impact of an additional ~$1,000 in Medicare inpatient cost-sharing on the likelihood of a Medicare beneficiary enrolling in Medicaid. Exogenous variation in Medicare deductible requirements will be used to compare Medicare enrollment among Medicare beneficiaries with similar hospital utilization but different out-of-pocket costs. An extended version of this analysis will examine whether beneficiaries who live in states that allow Medicare beneficiaries with high medical expenses to more easily qualify for Medicaid are more likely to enroll in Medicaid after incurring larger out-o-pocket costs. The study results will provide evidence for whether inpatient stays and Medicare cost-sharing trigger enrollment in Medicaid for Medicare beneficiaries. A better estimate of how beneficiaries respond to Medicare cost-sharing could lead to more precise estimates of whether reforms to Medicare's cost sharing provisions will increase or decrease Medicaid enrollment and related costs. As states and the Centers for Medicare and Medicaid Services design integrated programs for dual enrollees, these research findings will also inform strategies for effective care coordination for Medicare beneficiaries newly enrolling in Medicaid.