Racial/Ethnic Disparities in Medicare Advantage vs. Traditional Medicare: Evidence to Improve Equity in Medicare

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PROJECT SUMMARY / ABSTRACT In April 2023, states began to unwind provisions of the COVID-19 public health emergency that enabled people to remain continuously enrolled in Medicaid without completing periodic eligibility redeterminations. States are now required to re-evaluate eligibility for all Medicaid beneficiaries within 14 months. This change is beginning to affect 12.2 million low-income older adults and disabled individuals with Medicare and Medicaid, known as dual eligibles, who rely on Medicaid supplemental insurance for help paying Medicare premiums, cost sharing, and for some, services such as dental and long-term care. To maintain Medicaid coverage, older adult duals need to complete a complex redetermination process, accounting for programs with distinct eligibility rules, each of which requires detailed proof of income and assets. The complexity of the redetermination process raises concerns that older adults may experience abrupt changes in Medicaid or lose this coverage altogether. Prior studies, including those by our team, highlight the potential for loss of Medicaid supplemental insurance and variation in its effects according to individuals’ Medicare coverage (e.g., Medicare Advantage vs. traditional Medicare), health diagnoses (e.g., Alzheimer’s disease), and race/ethnicity. The extent of Medicaid loss may also vary based on state policies that simplify or automate Medicaid redeterminations. In this supplement to NIA grant R01AG076437, we propose to leverage national Medicare administrative data (which reports monthly Medicaid enrollment) and a soon-to-be-fielded survey under our parent R01 to examine individual-, Medicare plan- and policy-level determinants of Medicaid loss among older adults, assess older adults’ experiences with redeterminations, and identify racial and ethnic disparities in these outcomes. We will also examine the effects of Medicaid loss on health care use and disparities, focusing on outpatient visits and medication filling (sensitive to cost sharing in Medicare) and preventable hospitalizations (which may reflect adverse health outcomes). This supplement builds on our parent R01, which examines racial and ethnic health care disparities among older adults in Medicare Advantage vs. traditional Medicare, in three ways. First, we examine how changes in Medicaid coverage moderate racial and ethnic health care disparities among older adult Medicare beneficiaries. Second, we examine the role of factors at Medicare plan and state policy levels in mitigating Medicaid coverage loss and its effects on health care use and disparities. Third, we capitalize on a planned survey of Medicare beneficiaries for our parent R01, and include an additional sample of low-income older adults, to assess self-reported experiences navigating Medicaid redeterminations. By providing timely evidence about the effects of Medicaid redeterminations on low-income older adults, our research can guide future reforms to improve the continuity of Medicaid supplemental coverage and promote equitable care for low-income older adult Medicare beneficiaries.