Impact of Medicaid Policies on Low-Income Medicare Beneficiaries: Evidence From State Reforms

医疗补助政策对低收入医疗保险受益人的影响：来自国家改革的证据

• 批准号: 10227305
• 负责人: Noelle Cornelio
• 金额: $ 4.32万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10227305
• 关键词: Impact; Medicaid; Policies; Low; Income

PROJECT SUMMARY/ABSTRACT Approximately 12 million low-income Medicare beneficiaries are dually enrolled in Medicaid, which pays for services not covered by Medicare and defrays out-of-pocket costs, which can be substantial for relatively poor people. Medicare’s premiums, deductibles, and coinsurance average over 40% of an individual’s Social Security income, which represents the sole source or majority of income for many low-income Medicare beneficiaries. Medicaid coverage enables low-income Medicare beneficiaries to afford care they might otherwise forego due to cost. However, poor coordination between Medicare and Medicaid, complex Medicaid eligibility and enrollment rules, and state variation in Medicaid rules create substantial differences in who is eligible for and receives Medicaid. This proposal focuses on how variation in state Medicaid policy affects Medicaid enrollment, cost-related barriers to care, and heath care utilization in low-income aging and disabled populations. The proposed study will use recent Medicaid policy changes in Indiana and Ohio as a natural experiment to assess how increasing eligibility and simplifying enrollment impacted the low-income Medicare population. Data from the American Community Survey, Behavioral Risk Factor Surveillance System, and Medicare claims will be used to address the specific aims of this research. Aim 1 will estimate changes in Medicaid enrollment following eligibility expansions for low-income Medicare beneficiaries. Enrollment in Medicaid lowers out-of- pocket cost sharing requirements and facilitates care seeking. Therefore, Aim 2 will examine how access to care was affected by changes in Medicaid eligibility for low-income Medicare beneficiaries. Increases in health care utilization are expected for services where Medicare’s cost-sharing requirements are reduced or eliminated by Medicaid, and for services that may be sensitive to deferred preventive care use. Aim 3 will analyze changes in healthcare utilization after Medicaid eligibility expanded for low-income Medicare beneficiaries. Difference-in-differences and event study models will be utilized. The proposed project’s aims align with the Agency for Healthcare Research and Quality’s (AHRQ) mission “to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable,” and a Healthy People 2020 goal to improve access to care. Additionally, three AHRQ Priority Populations, the elderly, low-income, and those with special healthcare needs are the focus of the proposal. Findings from this proposal can inform future policy, research, and programs to promote access to care in low-income, aging, and disabled populations.

项目摘要/摘要 大约1200万低收入联邦医疗保险受益人双重参加了医疗补助计划，该计划为 医疗保险不覆盖的服务，并支付自付费用，这对相对贫穷的人来说可能是相当大的 人民。联邦医疗保险的保费、免赔额和共同保险平均超过个人社会保障的40% 安全收入，这是许多低收入医疗保险的唯一或大部分收入来源 受益人。医疗补助覆盖范围使低收入医疗保险受益人能够负担得起他们本可以负担的医疗费用 否则由于成本的原因而放弃。然而，医疗保险和医疗补助之间协调不力，复杂的医疗补助 资格和登记规则，以及医疗补助规则中的州差异，造成了谁是 有资格获得医疗补助。这项提案的重点是州医疗补助政策的变化如何影响 低收入老年人和残疾人的医疗补助登记、与费用相关的护理障碍和卫生保健利用 人口。 这项拟议的研究将使用印第安纳州和俄亥俄州最近的医疗补助政策变化作为自然实验，以 评估提高参保资格和简化参保对低收入医疗保险人群的影响。 来自美国社区调查、行为风险因素监测系统和医疗保险索赔的数据 将被用来解决本研究的具体目标。AIM 1将估计医疗补助登记人数的变化 在低收入医疗保险受益人的资格扩大后。参加医疗补助的人数减少 口袋费用分担要求，并促进寻求护理。因此，Aim 2将研究如何访问 医疗保健受到低收入医疗保险受益人医疗补助资格变化的影响。提高健康水平 对于降低了联邦医疗保险费用分担要求的服务或 被医疗补助取消，以及可能对延迟预防性护理使用敏感的服务。目标3将 分析低收入医疗保险扩大医疗补助资格后医疗利用的变化 受益人。将利用差异中的差异和事件研究模型。 拟议项目的目标与医疗保健研究和质量机构(AHRQ)的使命保持一致 提供证据，使卫生保健更安全、更高质量、更容易获得、更公平和负担得起。 健康人2020年的目标是改善获得护理的机会。此外，AHRQ的三个优先群体， 老年人、低收入者和有特殊医疗需求的人是提案的重点。由此得出的结论 提案可以为未来的政策、研究和计划提供信息，以促进低收入、老龄化和 残疾人口。

项目成果

Increasing Medicaid's Stagnant Asset Test For People Eligible For Medicare And Medicaid Will Help Vulnerable Seniors.

增加医疗补助对符合医疗保险和医疗补助资格的人的停滞资产测试将帮助弱势老年人。

• DOI: 10.1377/hlthaff.2021.00841
• 发表时间: 2021
• 期刊: Health affairs (Project Hope)
• 作者: Cornelio,Noelle;McInerney,MelissaPowell;Mellor,JenniferM;Roberts,EricT;Sabik,LindsayM
• 通讯作者: Sabik,LindsayM

How state surprise billing protections increased ED visits, 2007-2018: potential implications for the No Surprises Act.

2007 年至 2018 年，国家意外账单保护如何增加急诊就诊次数：对《无意外法案》的潜在影响。

• DOI: 10.37765/ajmc.2022.89226
• 发表时间: 2022
• 期刊: The American journal of managed care
• 作者: Encinosa,William;Lane,Keanan;Cornelio,Noelle
• 通讯作者: Cornelio,Noelle