The Newest "Burdensome Transition"? Moving from Medicaid Expansion Coverage to Medicare at Age 65

项目摘要 在每天年满65岁的1万名美国人中， 医疗法案的医疗补助扩张面临着一个独特的挑战：当他们 过渡到医疗保险作为他们的主要保险人，并面临更高的保费和自付费用。 保险覆盖范围的这种转变可能对获得护理产生有害影响，但几乎没有影响。 发表的研究，我们的知识，个人谁“年龄”的医疗补助扩张 保险和过渡到医疗保险作为他们的主要保险人。该提案的长期目标是 制定知情政策，确保低收入成年人获得全面、负担得起的保健服务 无论他们是接近65岁还是在另一边。这项研究的直接目标是 了解64岁的医疗补助扩展登记者在多大程度上失去或保留医疗补助福利， 过渡到医疗保险，以及这如何影响他们住院甚至死亡的风险。我们的中央 假设是，许多接近老年的成年人与医疗补助扩大覆盖范围不保留完整的医疗补助 福利，特别是在那些不那么慷慨的双重资格标准的州， 影响他们获得医疗服务的能力。为了评估我们的假设，我们将解决这些具体目标：1） 确定与失去或保留Medicaid相关的个人特征和州一级政策 在64岁时通过医疗补助扩大覆盖的个人中，65岁时的覆盖率，以及2） 评估在过渡到Medicare时失去全部医疗补助福利是否会对急性 在医疗保险覆盖的第一年和之后的三年内， 过渡为了实现这些目标，我们建议使用2014年和2015年的医疗补助登记和索赔数据 对于八个大的医疗补助扩展州（加州、伊利诺伊州、马里兰州、马萨诸塞州、新泽西、新泽西州）， 约克、俄亥俄州和宾夕法尼亚州），以确定与Medicare登记相关的64岁人群 2018年的索赔数据第一个目标将采用纵向研究设计，以检查模式的损失 以及在64岁时拥有医疗补助扩大覆盖范围的个人中保留医疗补助福利， 然后在65岁时过渡到医疗保险。目标2将采用准实验研究设计， 急性住院率和死亡率之前和之后过渡到医疗保险在65岁， 当他们成为医疗保险受益人时， 以及失去医疗补助的人群中这项工作是创新的，因为它将是第一项研究， 医疗补助和医疗保险登记和索赔数据，以研究这一人群随着时间的推移。这项工作意义重大 因为它将揭示医疗补助扩大覆盖范围的老年人在他们 过渡到医疗。通过这项工作获得的见解可以为扩大医疗补助资格的努力提供信息， 65岁以上人口的扩大以及将医疗保险扩大到65岁以下个人的提议。

PROJECT SUMMARY Among the 10,000 Americans turning 65 every day, those with health insurance coverage under the Affordable Care Act's Medicaid expansion face a unique challenge: They may lose Medicaid coverage when they transition to Medicare as their primary insurer and face substantially higher premium and out-of-pocket costs. This transition in insurance coverage may have deleterious effects on access to care, but there is little published research to our knowledge about the individuals who “age out” of Medicaid expansion coverage and transition to Medicare as their primary insurer. The long-term goal of this proposal is to inform policies to ensure that adults with low incomes have access to comprehensive, affordable health care whether they are nearing age 65 or are on the other side of it. The immediate objective of this research is to understand the extent to which 64-year-old Medicaid expansion enrollees lose or retain Medicaid benefits upon transitioning to Medicare and how this impacts their risk of hospitalization and even death. Our central hypotheses are that many near-elderly adults with Medicaid expansion coverage do not retain full Medicaid benefits when they turn 65, particularly in states with less generous dual eligibility criteria, and this negatively affects their ability to access care. To evaluate our hypotheses, we will address these specific aims: 1) Identify individual characteristics and state-level policies associated with the loss or retention of Medicaid coverage at age 65 among individuals who had coverage through Medicaid expansion as 64-year-olds, and 2) evaluate whether the loss of full Medicaid benefits upon transitioning to Medicare impacts acute hospitalizations and all-cause mortality in the first year of Medicare coverage and up to three years after transitioning. To achieve these aims, we propose to use 2014 and 2015 Medicaid enrollment and claims data for eight large Medicaid expansion states (California, Illinois, Maryland, Massachusetts, New Jersey, New York, Ohio, and Pennsylvania) to identify a cohort of 64-year-olds that can be linked to Medicare enrollment and claims data through 2018. The first aim will apply a longitudinal study design to examine patterns of loss and retention of Medicaid benefits among individuals who had Medicaid expansion coverage at age 64 and then transitioned to Medicare at age 65. Aim 2 will apply a quasi-experimental study design to compare the rate of acute hospitalizations and the mortality rate before and after the transition to Medicare at age 65 among the group of Medicaid expansion enrollees who retained Medicaid when they became Medicare beneficiaries, and among the group that lost Medicaid. This work is innovative because it will be the first study to link Medicaid and Medicare enrollment and claims data to study this population over time. This work is significant because it will reveal whether older adults with Medicaid expansion coverage may be worse off when they transition to Medicare. Insights gained through this work can inform efforts to expand Medicaid eligibility to the expansion population over age 65 and proposals to expand Medicare to individuals under age 65.