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

项目总结/摘要 大约有1200万低收入医疗保险受益人双重参加了医疗补助计划， 医疗保险不包括的服务，并支付自付费用，这对相对贫困的人来说可能是巨大的 人医疗保险的保费、免赔额和共同保险平均超过个人社会保险的40%。 保障收入，这是许多低收入医疗保险计划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可能需要的医疗服务。 否则由于成本而放弃。然而，医疗保险和医疗补助之间协调不力，医疗补助复杂， 资格和登记规则，以及医疗补助规则的州差异，在谁是 有资格获得医疗补助。这项提案的重点是如何在国家医疗补助政策的变化影响 低收入老年人和残疾人的医疗补助登记、成本相关的护理障碍和医疗保健利用 人口。 这项拟议中的研究将利用印第安纳州和俄亥俄州最近的医疗补助政策变化作为一项自然实验， 评估增加资格和简化登记如何影响低收入医疗保险人群。 数据来自美国社区调查、行为风险因素监测系统和医疗保险索赔 将用于解决本研究的具体目标。目标1将估计医疗补助登记的变化 低收入医疗保险受益人的资格扩大后。医疗补助计划的入学率降低了 支付费用分担要求，并方便寻求护理。因此，目标2将研究如何获得 医疗保健受到低收入医疗保险受益人的医疗补助资格变化的影响。增加健康 医疗服务的利用率预计会降低， 被医疗补助计划取消，以及可能对延迟预防性护理使用敏感的服务。目标3将 分析医疗补助资格扩大后低收入医疗保险的医疗保健利用率变化 受益人。将使用差异中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）的使命一致， 提供证据，使卫生保健更安全，更高质量，更容易获得，公平和负担得起，”和 2020年健康人的目标是改善医疗服务。此外，三个AHRQ优先群体， 长者、低收入人士及有特殊医疗需要的人士是建议的重点。时发现的问题 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。

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.