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

项目总结/摘要 2023年4月，各州开始解除COVID-19公共卫生紧急状态的规定， 继续参加医疗补助计划，而无需完成定期资格重新确定。国 现在要求在14个月内重新评估所有医疗补助受益人的资格。这种变化正在开始 影响1220万低收入老年人和残疾人的医疗保险和医疗补助， 双杀，谁依靠医疗补助补充保险帮助支付医疗保险保费，成本分摊， 对一些人来说，还有牙科和长期护理等服务。为了维持医疗补助覆盖范围，老年人 需要完成复杂的重新确定过程，考虑具有不同资格规则的计划， 每一项都需要详细的收入和资产证明。重新确定进程的复杂性 这引起了人们的担忧，老年人可能会经历医疗补助的突然变化或完全失去这种覆盖范围。 先前的研究，包括我们团队的研究，强调了医疗补助补充保险损失的可能性。 以及根据个人的医疗保险覆盖范围其效果的变化（例如，Medicare Advantage与 传统的医疗保险），健康诊断（例如，阿尔茨海默病）和种族/民族。医疗补助的范围 损失也可能因简化或自动化医疗补助重新确定的州政策而异。在这 作为NIA补助金R 01 AG 076437补充，我们建议利用国家医疗保险管理数据（ 报告每月的医疗补助登记）和即将在我们的父R 01下进行的调查， 老年人医疗补助损失的个人、医疗保险计划和政策层面的决定因素， 成年人的经验与重新决定，并确定种族和民族的差异，这些结果。我们将 还研究了医疗补助损失对医疗保健使用和差异的影响，重点是门诊就诊， 药物填充（对医疗保险中的费用分摊敏感）和可预防的住院治疗（可能反映 不良健康后果）。这种补充建立在我们的父R 01，它检查种族和民族的健康 老年人在医疗保险优势与传统医疗保险中的护理差异，在三个方面。一是 研究医疗补助覆盖范围的变化如何缓和老年人中的种族和民族医疗保健差异 成人医疗保险受益人其次，我们研究了医疗保险计划和国家政策层面因素的作用， 减轻医疗补助覆盖范围的损失及其对医疗保健使用和差异的影响。第三，我们利用 计划对我们的父母R 01的医疗保险受益人进行调查，并包括低收入人群的额外样本 老年人，以评估自我报告的经验导航医疗补助重新确定。提供及时 关于医疗补助重新确定对低收入老年人影响的证据，我们的研究可以指导 未来的改革，以改善医疗补助补充覆盖的连续性，并促进公平的照顾， 低收入老年人医疗保险受益人。

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.