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Journal articles on the topic 'Medicare eligibility'

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Published: 10 December 2022
Last updated: 28 January 2023

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1

Calinsky, Jackie. "MEDICARE ELIGIBILITY." AJN, American Journal of Nursing 104, no. 12 (December 2004): 15. http://dx.doi.org/10.1097/00000446-200412000-00005.

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2

Scala-Foley, Marisa A. "MEDICARE ELIGIBILITY." AJN, American Journal of Nursing 104, no. 12 (December 2004): 15–16. http://dx.doi.org/10.1097/00000446-200412000-00006.

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3

ZUBER, REBECCA FRIEDMAN. "Assessing Medicare Eligibility." Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional 20, no. 7 (July 2002): 425–30. http://dx.doi.org/10.1097/00004045-200207000-00005.

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4

Yang, Zhou, Cheng Huang, and Victoria Phillips. "Medicare Eligibility Age, Health Disparities, and Medicare Reform." Journal of Health Care for the Poor and Underserved 25, no. 3 (2014): 1379–83. http://dx.doi.org/10.1353/hpu.2014.0119.

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5

Scala-Foley, Marisa A., Judith T. Caruso, Ruchel Ramos, and Susan C. Reinhard. "Medicare Eligibility, Enrollment, and Coverage." AJN, American Journal of Nursing 104, no. 2 (February 2004): 81–83. http://dx.doi.org/10.1097/00000446-200402000-00028.

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6

Benevides, Teal W., Henry J. Carretta, George Rust, and Lindsay Shea. "Racial and ethnic disparities in benefits eligibility and spending among adults on the autism spectrum: A cohort study using the Medicare Medicaid Linked Enrollees Analytic Data Source." PLOS ONE 16, no. 5 (May 25, 2021): e0251353. http://dx.doi.org/10.1371/journal.pone.0251353.

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Background Research on children and youth on the autism spectrum reveal racial and ethnic disparities in access to healthcare and utilization, but there is less research to understand how disparities persist as autistic adults age. We need to understand racial-ethnic inequities in obtaining eligibility for Medicare and/or Medicaid coverage, as well as inequities in spending for autistic enrollees under these public programs. Methods We conducted a cross-sectional cohort study of U.S. publicly-insured adults on the autism spectrum using 2012 Medicare-Medicaid Linked Enrollee Analytic Data Source (n = 172,071). We evaluated differences in race-ethnicity by eligibility (Medicare-only, Medicaid-only, Dual-Eligible) and spending. Findings The majority of white adults (49.87%) were full-dual eligible for both Medicare and Medicaid. In contrast, only 37.53% of Black, 34.65% Asian/Pacific Islander, and 35.94% of Hispanic beneficiaries were full-dual eligible for Medicare and Medicare, with most only eligible for state-funded Medicaid. Adjusted logistic models controlling for gender, intellectual disability status, costly chronic condition, rural status, county median income, and geographic region of residence revealed that Black beneficiaries were significantly less likely than white beneficiaries to be dual-eligible across all ages. Across these three beneficiary types, total spending exceeded $10 billion. Annual total expenditures median expenditures for full-dual and Medicaid-only eligible beneficiaries were higher among white beneficiaries as compared with Black beneficiaries. Conclusions Public health insurance in the U.S. including Medicare and Medicaid aim to reduce inequities in access to healthcare that might exist due to disability, income, or old age. In contrast to these ideals, our study reveals that racial-ethnic minority autistic adults who were eligible for public insurance across all U.S. states in 2012 experience disparities in eligibility for specific programs and spending. We call for further evaluation of system supports that promote clear pathways to disability and public health insurance among those with lifelong developmental disabilities.
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7

Glynn, Alexandra, Inmaculada Hernandez, and Eric Roberts. "Effects of Medicare Drug Subsidies on Adherence for Diabetics: Evidence From a Regression Discontinuity Design." Innovation in Aging 4, Supplement_1 (December 1, 2020): 280. http://dx.doi.org/10.1093/geroni/igaa057.896.

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Abstract Out-of-pocket prescription drug costs are rapidly rising, particularly for insulin, which is a life-saving drug used by 3.1 million diabetics on Medicare. High out-of-pocket costs place an accentuated financial strain on older adults with diabetes, many of whom have low incomes, and may impede medication adherence, leading to poor health outcomes. The Medicare Part D Low-Income Subsidy (LIS) program limits drug co-pays to under $8.50 per prescription and caps out-of-pocket drug costs for lowest-income recipients (<135% Federal Poverty Level, FPL), resulting in pronounced differences in out-of-pocket costs for those with marginally different incomes. Using detailed income data from the Health and Retirement Study linked to Medicare claims (2008-2016), we employed a regression discontinuity (RD) design to isolate the effects of differences in out-of-pocket costs at eligibility thresholds for the LIS. Diabetic beneficiaries whose income exceeded the LIS eligibility threshold had lower Part D spending (-$945/year, p=0.03, n=2,367) and adherence to oral antidiabetic drugs (-8%, p=0.02). We conducted secondary analyses at the eligibility threshold for Medicaid, as individuals whose income exceeds the eligibility limit for Medicaid (100% of FPL in most states) are significantly less likely to receive the LIS. Above the Medicaid eligibility threshold (n=2,295), annual spending on insulin was $395 lower (p=0.002) and proportion of insulin use was 6% lower (p=0.04). These results suggest low-income Medicare beneficiaries who are not shielded from out-of-pocket costs via the LIS are particularly sensitive to drug costs. Policy proposals to limit out-of-pocket costs could improve medication adherence to high-cost drugs for vulnerable beneficiaries.
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8

Davidoff, Amy J., Lindsey Enewold, Courtney Williams, Manami Bhattacharya, and Janeth I. Sanchez. "Reliability of cancer registry primary payer information and implications for policy research." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): 1587. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.1587.

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1587 Background: Researchers commonly use “Primary Payer at Diagnosis” measured in cancer registry data to assess the impact of health policy, such as the Affordable Care Act, on insurance, and the impact of insurance on cancer care and outcomes. Measurement error may bias estimated effect size and significance. Little is known about patterns of Medicaid or Medicare misreporting in registry databases commonly used for policy analysis. Methods: We used the National Cancer Institute’s Surveillance, Epidemiology and End Results registry data for adults aged 19-64 years at diagnosis with known cancer stage, linked to most recently available (2007-2011) CMS records on Medicaid and Medicare enrollment at diagnosis month. We recoded the registry Primary Payer variable into 6 categories: private/managed care, Medicare, Medicaid, other government, status unknown, uninsured. State-year policy data regarding Medicaid eligibility and managed care enrollment were also linked. We compared the registry data to Medicaid and/or Medicare enrollment data, and calculated underreporting rates by patient characteristics and state policy. Results: The linked sample (N = 896,031) was 68% non-Hispanic white, 49% male. Overall, the registry data reported 7.8% Medicare and 10.1% Medicaid, while enrollment was 5.5% Medicare, 10.4% Medicaid, and 3.4% dual Medicare-Medicaid. The registry data concordantly identified 61.4% and 57.7% of persons identified per enrollment data to be Medicaid-only and Medicare-only, respectively (Table). Most Medicaid-only enrollees without concordant registry information were reported to have private insurance or be uninsured. Medicaid underreporting (39% overall), was higher for males (43%) vs females (37%), in low (46%) vs high (38%) poverty areas, for Medicaid poverty expansion or waiver enrolled (50%) vs cash assistance related eligibility (33%), and in states with large managed care enrollment, all at p<.001. If Medicaid and Medicare enrollment data were used to edit the registry data, 8% of persons would switch insurance assignment. Conclusions: Primary Payer data reported by cancer registries are subject to measurement error and may result in biased estimates of insurance-related policy impacts. Enhancement with objective Medicaid and Medicare enrollment data will reduce measurement error and may result in unbiased estimates necessary to support policy assessment. [Table: see text]
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9

Wang, Jinjiao, Thomas V. Caprio, Helena Temkin-Greener, Xueya Cai, jingjing Shang, and Yue Li. "RELATIONSHIP OF DEMENTIA AND MEDICAID ELIGIBILITY WITH FACILITY ADMISSIONS IN MEDICARE HOME HEALTH PATIENTS." Innovation in Aging 3, Supplement_1 (November 2019): S880. http://dx.doi.org/10.1093/geroni/igz038.3225.

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Abstract This study was a secondary analysis of the Outcome and Assessment Information Set (OASIS) and administrative billing records of 6,153 adults ≥ 65 years old who received home health (HH) from a not-for-profit HH agency in upstate New York between 01/01/2017 and 12/31/2017. We examined the relationships of dementia and Medicare-Medicaid dual eligibility with unplanned institutional admission (i.e. to hospital, nursing home, or inpatient rehabilitation facility) among these HH recipients. Dementia was identified by ICD-10 codes and OASIS items (M1700, M1710, M1740). We also used OASIS record to identify dual eligible status (M0150) and unplanned facility admission (M2410 [occurrence], M0906 [date], M2430 [reason]). Time-to-facility admission was defined as the number of days from HH start date to the facility admission date. The rate of having an unplanned facility admission was 14.2% among Medicare-only patients without dementia, 15.8% among dual eligible patients without dementia, 16.7% among Medicare-only patients with dementia, and 39.3% among dual eligible patients with dementia (p&lt;0.001). In the multivariable Cox proportional hazard model of time-to-facility admission adjusting for patient covariates, dually eligible patients with dementia were more than twice as likely as Medicare-only patients without dementia to have an unplanned facility admission (Hazard Ratio=2.35, p=0.006). This is the first study that identified synergistic effects of having both dementia and Medicare-Medicaid dual eligibility on increasing the risk of healthcare facility admission in the Medicare HH population in the United States. Policies should ensure that appropriate and sufficient HH services be provided for dually eligible patients with dementia.
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10

Cher, Benjamin A. Y., Andrew M. Ryan, Geoffrey J. Hoffman, and Kyle H. Sheetz. "Association of Medicaid Eligibility With Surgical Readmission Among Medicare Beneficiaries." JAMA Network Open 3, no. 6 (June 10, 2020): e207426. http://dx.doi.org/10.1001/jamanetworkopen.2020.7426.

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11

Black, Beverly L. "Medicare beneficiaries’ eligibility for HMO coverage." American Journal of Health-System Pharmacy 42, no. 4 (April 1, 1985): 758–65. http://dx.doi.org/10.1093/ajhp/42.4.758.

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12

Nemesure, Barbara, April Plank, Lisa Reagan, Denise Albano, Michael Reiter, and Thomas V. Bilfinger. "Evaluating efficacy of current lung cancer screening guidelines." Journal of Medical Screening 24, no. 4 (February 15, 2017): 208–13. http://dx.doi.org/10.1177/0969141316689111.

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Objective Current lung cancer screening criteria based primarily on outcomes from the National Lung Screening Trial may not adequately capture all subgroups of the population at risk. We aimed to evaluate the efficacy of lung cancer screening criteria recommended by the United States Preventive Services Task Force, Centers for Medicare and Medicaid Services, and the National Comprehensive Cancer Network in identifying known cases of lung cancer. Methods An investigation of the Stony Brook Cancer Center Lung Cancer Evaluation Center's database identified 1207 eligible, biopsy-proven lung cancer cases diagnosed between January 1996 and March 2016. Age at diagnosis, smoking history, and other known risk factors for lung cancer were used to determine the proportion of cases that would have met current United States Preventive Services Task Force, Centers for Medicare and Medicaid Services, and National Comprehensive Cancer Network eligibility requirements for lung cancer screening. Results Of the 1046 ever smokers in the study, 40% did not meet the National Lung Screening Trial age requirements, 20% did not have a ≥30 pack year smoking history, and approximately one-third quit smoking >15 years before diagnosis, thus deeming them ineligible for screening. Applying the United States Preventive Services Task Force, Centers for Medicare and Medicaid Services, and National Comprehensive Cancer Network eligibility criteria to the Stony Brook Cancer Center's Lung Cancer Evaluation Center cases, 49.2, 46.3, and 69.8%, respectively, would have met the current lung cancer screening guidelines. Conclusions The United States Preventive Services Task Force and Centers for Medicare and Medicaid Services eligibility criteria for lung cancer screening captured less than 50% of lung cancer cases in this investigation. These findings highlight the need to reevaluate the efficacy of current guidelines and may have major public health implications.
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13

Hua, Cassandra, Portia Cornell, Elizabeth White, Katherine Kennedy, Ian Nelson, and Kali Thomas. "DUAL ELIGIBILITY AND INJURY-RELATED EMERGENCY DEPARTMENT VISITS AMONG ASSISTED LIVING RESIDENTS." Innovation in Aging 6, Supplement_1 (November 1, 2022): 421. http://dx.doi.org/10.1093/geroni/igac059.1655.

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Abstract Using 2018 Medicare data, we examined the relationship between dual eligibility and injury-related emergency department use among a cohort of assisted living residents (n=116,754). We fit multilevel models with random intercepts at the assisted living community and license type levels. The baseline rate of injury-related emergency department emergency department use was 0.17. After controlling for resident characteristics (i.e., age, sex, race, and chronic conditions), license type characteristics (i.e., dementia care licensure, staffing regulations), and assisted living community characteristics (i.e., size and percentage of residents with dementia), being dually eligible for Medicare and Medicaid was associated with a 12% increase in the probability of having an injury-related emergency department visit (b=.02; p&lt;.001). Assisted living communities that serve duals may have fewer resources and staff to provide personal care, potentially leading to increased rates of injuries.
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14

Witman, Allison. "Public health insurance and disparate eligibility of spouses: The Medicare eligibility gap." Journal of Health Economics 40 (March 2015): 10–25. http://dx.doi.org/10.1016/j.jhealeco.2014.10.007.

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15

Datto, Catherine J., Yiqun Hu, Eric Wittbrodt, and Perry G. Fine. "Cancer and non-cancer pain opioid utilization in Medicare and Medicaid populations." Journal of Clinical Oncology 36, no. 7_suppl (March 1, 2018): 139. http://dx.doi.org/10.1200/jco.2018.36.7_suppl.139.

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139 Background: Limited data exist comparing opioid use patterns in Medicare and Medicaid patients with cancer-related (CP) and non-cancer-related pain (NCP). Methods: A retrospective analysis of Medicare and Medicaid claims data (MarketScan Research Databases) investigated opioid use patterns in patients with CP and NCP. Adults (age ≥18 yr) with ≥1 pharmacy claim for an opioid (index date), continuous plan eligibility for 6 months pre- and 12 months post-index date, and duration of opioid use of ≥4 weeks were identified. CP patients were identified by medical claim for a cancer diagnosis within 30 days before index date. Results: A total of 4,009 Medicare and 551 Medicaid patients with CP and 98,631 Medicare and 25,163 Medicaid patients with NCP were analyzed. The most common cancer diagnoses were breast, lung, prostate, and colorectal. Medicare patients with CP and NCP had similar mean age; in the Medicaid cohort, patients with CP were older than those with NCP. In the Medicare cohort, NCP patients were more likely to be women; sex distribution was similar among Medicaid patients. Higher rates of comorbidity in the CP cohorts were observed in both datasets. Median index and post-index opioid doses were consistent between the CP and NCP cohorts. The post-index pattern of change in opioid dose was consistent between CP and NCP in both Medicare and Medicaid patients. The most common pattern observed was up to a doubling of index dose. Conclusions: Similar opioid utilization patterns in Medicare and Medicaid populations, including dose escalation, were observed regardless of pain etiology (cancer or non-cancer). [Table: see text]
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16

Aggarwal, Rahul, Robert W. Yeh, Issa J. Dahabreh, Sarah E. Robertson, and Rishi K. Wadhera. "Medicare eligibility and healthcare access, affordability, and financial strain for low- and higher-income adults in the United States: A regression discontinuity analysis." PLOS Medicine 19, no. 10 (October 4, 2022): e1004083. http://dx.doi.org/10.1371/journal.pmed.1004083.

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Background US policymakers are debating whether to expand the Medicare program by lowering the age of eligibility. The goal of this study was to determine the association of Medicare eligibility and enrollment with healthcare access, affordability, and financial strain from medical bills in a contemporary population of low- and higher-income adults in the US. Methods and findings We used cross-sectional data from the National Health Interview Survey (2019) to examine the association of Medicare eligibility and enrollment with outcomes by income status using a local randomization-based regression discontinuity approach. After weighting to account for survey sampling, the low-income group consisted of 1,660,188 adults age 64 years and 1,488,875 adults age 66 years, with similar baseline characteristics, including distribution of sex (59.2% versus 59.7% female) and education (10.8% versus 12.5% with bachelor’s degree or higher). The higher-income group consisted of 2,110,995 adults age 64 years and 2,167,676 adults age 66 years, with similar distribution of baseline characteristics, including sex (40.0% versus 49.4% female) and education (41.0% versus 41.6%). The share of adults age 64 versus 66 years enrolled in Medicare differed within low-income (27.6% versus 87.8%, p < 0.001) and higher-income groups (8.0% versus 85.9%, p < 0.001). Medicare eligibility at 65 years was associated with a decreases in the percentage of low-income adults who delayed (14.7% to 6.2%; −8.5% [95% CI, −14.7%, −2.4%], P = 0.007) or avoided medical care (15.5% to 5.9%; −9.6% [−15.9%, −3.2%], P = 0.003) due to costs, and a larger decrease in the percentage who were worried about (66.5% to 51.1%; −15.4% [−25.4%, −5.4%], P = 0.003) or had problems (33.9% to 20.6%; −13.3% [−23.0%, −3.6%], P = 0.007) paying medical bills. In contrast, there were no significant associations between Medicare eligibility and measures of cost-related barriers to medication use. For higher-income adults, there was a large decrease in worrying about paying medical bills (40.5% to 27.5%; −13.0% [−21.4%, −4.5%], P = 0.003), a more modest decrease in avoiding medical care due to cost (3.5% to 0.6%; −2.9% [−5.3%, −0.5%], P = 0.02), and no significant association between eligibility and other measures of healthcare access and affordability. All estimates were stronger when examining the association of Medicare enrollment with outcomes for low and higher-income adults. Additional analyses that adjusted for clinical comorbidities and employment status were largely consistent with the main findings, as were analyses stratified by levels of educational attainment. Study limitations include the assumption adults age 64 and 66 would have similar outcomes if both groups were eligible for Medicare or if eligibility were withheld from both. Conclusions Medicare eligibility and enrollment at age 65 years were associated with improvements in healthcare access, affordability, and financial strain in low-income adults and, to a lesser extent, in higher-income adults. Our findings provide evidence that lowering the age of eligibility for Medicare may improve health inequities in the US.
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17

Wang, Jinjiao, Thomas V. Caprio, Helena Temkin-Greener, Xueya Cai, Adam Simning, and Yue Li. "Relationship of Medicare–Medicaid Dual Eligibility and Dementia With Unplanned Facility Admissions Among Medicare Home Health Care Recipients." Journal of Aging and Health 32, no. 9 (January 15, 2020): 1178–87. http://dx.doi.org/10.1177/0898264319899211.

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Objective: The objective of this study was to examine the effects of dementia and Medicare–Medicaid dual eligibility on unplanned facility admission among older Medicare home health (HH) recipients. Method: This study involves a secondary analysis of data from the Outcome and Assessment Information Set (OASIS) and billing records (i.e., International Classification of Diseases, 10th Revision [ICD-10] codes) of 6,153 adults ≥ 65 years receiving HH from a nonprofit HH agency in CY 2017. Results: Among dual eligible patients with dementia, 39.3% had an unplanned facility admission of any type, including the hospital, nursing home, or rehabilitation facility. In the multivariable Cox proportional hazard model of time-to-facility admission, dual eligible patients with dementia were more than twice as likely as Medicare-only patients without dementia to have an unplanned facility admission (hazard ratio = 2.35; 95% confidence interval: 1.28, 4.33; p = .006). Discussion: Low income and dementia have interactive effects on facility admissions. Among Medicare HH recipients, dual eligible patients with dementia are the most vulnerable group for unplanned facility admission.
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18

Taylor, Kathryn, Stanley M. Kalata, Ushapoorna Nuliyalu,, and Hari Nathan. "Association of Medicare and Medicaid Dual Eligibility with Skilled Nursing Facility Quality." Journal of the American College of Surgeons 235, no. 5 (October 17, 2022): S124—S125. http://dx.doi.org/10.1097/01.xcs.0000893916.17845.18.

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19

Zuckerman, Stephen, Baoping Shang, and Timothy Waidmann. "Medicare Savings Programs: Analyzing Options for Expanding Eligibility." Inquiry 46, no. 4 (December 2009): 391–404. http://dx.doi.org/10.5034/inquiryjrnl_46.4.391.

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20

Halloran, Laurel. "Contraceptive Case Studies: 2011 CDC Medicare Eligibility Criteria." Journal for Nurse Practitioners 8, no. 4 (April 2012): 332–33. http://dx.doi.org/10.1016/j.nurpra.2012.01.003.

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21

Huesch, Marco D., and Michael K. Ong. "Prostate Cancer Care Before and After Medicare Eligibility." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 53 (January 16, 2016): 004695801664729. http://dx.doi.org/10.1177/0046958016647298.

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22

Huesch, Marco D., and Michael K. Ong. "Lung Cancer Care Before and After Medicare Eligibility." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 53 (January 16, 2016): 004695801664730. http://dx.doi.org/10.1177/0046958016647301.

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23

Meyer, Christian P., Christopher B. Allard, Jesse D. Sammon, Julian Hanske, Julia McNabb-Baltar, Joel E. Goldberg, Gally Reznor, et al. "Data on Medicare eligibility and cancer screening utilization." Data in Brief 7 (June 2016): 679–81. http://dx.doi.org/10.1016/j.dib.2016.02.049.

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24

Berenson, Robert A. "Medicare's Stewardship Role to Improve Care Delivery: Opportunities for the Biden Administration." Journal of Health Politics, Policy and Law 46, no. 4 (August 1, 2021): 627–39. http://dx.doi.org/10.1215/03616878-8970838.

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Abstract Medicare initiatives have been instrumental in improving care delivery and payment as exemplified by its role in broadly expanding the use of telehealth during the COVID-19 pandemic. Medicare innovations have been adopted or adapted in Medicaid and by private payers, while Medicare Advantage plans successfully compete with traditional Medicare only because their payment rates are tied by regulation to those in the traditional Medicare program. However, Medicare has not succeeded in implementing new, value-based payment approaches that also would serve as models for other payers, nor has Medicare succeeded in improving quality by relying on public reporting of measured performance. It is increasingly clear that burdensome attention to measurement and reporting distracts from what could be successful efforts to actually improve care through quality improvement programs, with Medicare leading in partnership with providers, other payers, and patients. Although Congress is unlikely to adopt President Biden's proposals to decrease the eligibility age for Medicare or to adopt a public option based on Medicare prices and payment methods in the marketplaces, the Biden administration has an opportunity to provide overdue, strategic direction to the pursuit of value-based payments and to replace failed pay-for-performance with provider-managed projects to improve quality and reduce health disparities.
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Vaughan, Molly W., Ila H. Broyles, Melvin J. Ingber, Lauren A. Palmer, Tara McMullen, Karyn K. Anderson, and Anne Deutsch. "THE EFFECT OF DUAL ELIGIBILITY ON IMPROVEMENT IN MOBILITY: VARIATION BY PATIENTS’ PRIMARY DIAGNOSIS." Innovation in Aging 3, Supplement_1 (November 2019): S501—S502. http://dx.doi.org/10.1093/geroni/igz038.1856.

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Abstract Dually eligible individuals (i.e., eligible for Medicare and Medicaid) often have worse health and greater functional limitations than patients eligible for Medicare only. For dually eligible patients receiving inpatient rehabilitation services following a major illness or injury, improvement in function may be lower than for Medicare-only patients. To our knowledge, this is the first study to examine the relationship of dual eligibility on improvement in mobility for inpatient rehabilitation facility (IRF) patients by 13 primary diagnosis groups (e.g., Stroke, Amputation). Data was collected on the IRF-Patient Assessment Instrument at admission and discharge for all IRF patients discharged during 2017 (N = 428,631). A generalized linear model was run for each primary diagnosis group to examine the effect of dual eligibility on change in mobility during an IRF stay, adjusting for sociodemographic factors, clinical factors, and comorbidities. The proportion of patients who were dually eligible varied among primary diagnosis groups (9.6% for Hip/Knee Replacements, Fractures and Multiple Trauma to 21.7% for Amputation). Compared to patients who were non-dually eligible, dually eligible patients had lower improvement in mobility across all 13 diagnostic groups. The strongest effect of dual eligibility on lower improvement in mobility was among patients with hip and/or knee replacements (β: -1.99, p&lt;0.001) and patients with non-traumatic spinal cord dysfunction (β: -1.83, p&lt;0.001). This research indicates that dually eligible patients may have worse functional mobility outcomes than non-dually eligible patients for some IRF primary diagnosis groups, and these patients may need additional support after discharge.
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Slayter, Elspeth. "Adults With Dual Eligibility for Medicaid and Medicare: Access to Substance Abuse Treatment." Journal of Social Work in Disability & Rehabilitation 10, no. 2 (April 2011): 67–81. http://dx.doi.org/10.1080/1536710x.2011.571482.

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27

Bradley, Cathy J., Bassam Dahman, and Charles W. Given. "Treatment and Survival Differences in Older Medicare Patients With Lung Cancer as Compared With Those Who Are Dually Eligible for Medicare and Medicaid." Journal of Clinical Oncology 26, no. 31 (November 1, 2008): 5067–73. http://dx.doi.org/10.1200/jco.2008.16.3071.

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Purpose This study compares non–small-cell lung cancer (NSCLC) treatments provided to older patients (age ≥ 66 years) who are dually eligible for Medicare and Medicaid with treatments provided to similar patients who are insured by Medicare. We extend the analysis to include a comparison of survival rates between Medicare and dually eligible patients. Dual eligibility is associated with low socioeconomic status. However, Medicaid coverage in addition to Medicare removes many financial barriers to care. Patients and Methods The sample included 2,626 older patients with local and regional stage NSCLC diagnosed between 1997 and 2000. Four outcomes were studied: the likelihood of receiving resection, chemotherapy, radiation therapy, and survival (perioperative and longer-term). Logistic regression was used to predict the likelihood of treatment, and stratified and multivariate analyses were used to evaluate differences in survival. Results Dually eligible patients were half as likely to undergo resection as Medicare patients (P < .001) and were more likely to receive radiation than Medicare patients. Stratified and multivariate analyses showed that surgically treated dually eligible patients had slightly inferior survival as compared with that of Medicare patients. Survival was equivalent among patients who did not undergo resection, regardless of insurance coverage. Conclusion Older dually eligible patients with NSCLC had a lower likelihood of undergoing resection despite controls for socioeconomic factors and comorbidities. However, if such patients were surgically treated, survival improved substantially, but it remained inferior to the survival of Medicare patients. Additional research is needed to understand why resection rates were substantially lower among dually eligible patients.
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28

Rivera-Hernandez, Maricruz, Aaron Castillo, and Amal Trivedi. "Predictors of Disenrollment Among Medicare Fee-for-Service Beneficiaries With Dementia." Innovation in Aging 5, Supplement_1 (December 1, 2021): 17–18. http://dx.doi.org/10.1093/geroni/igab046.062.

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Abstract Medicare enrollment among people with Alzheimer’s Disease and Related Dementias (ADRD) has reached an all-time high with about 12% of beneficiaries having an ADRD diagnosis. The federal government has special interest in providing healthcare alternatives for Medicare beneficiaries. However, limited studies have focused on understanding disenrollment from fee-for-service, especially among those with high-needs. In this study we identified predictors of disenrollment among beneficiaries with ADRD. We used the 2017-2018 Medicare Master Beneficiary Summary File to determine enrollment, sociodemographic, clinical characteristics and healthcare utilization. We included all fee-for-service beneficiaries enrolled in 2017 who survived the first quarter of 2018. Our primary outcome was disenrollment from fee-for-service between 2017 and 2018. Regression models included age, sex, race/ethnicity, dually eligibility to Medicare and Medicaid, chronic and disabling conditions (categorized by quartiles), total health care costs including outpatient, inpatient, post-acute care and other costs (categorized by quartiles) and county fixed-effects. There were 1,797,047 beneficiaries enrolled in fee-for-service with an ADRD diagnosis. Stronger predictors of disenrollment included race/ethnicity and dual eligibility. Disenrollment rates were 7.9% (95% CI, 7.2 – 8.5) among African Americans, 6.6 (95% CI, 6.2 – 7.0) among Hispanics and 4.3 (95% CI, 4.2 – 4.3) among Whites. Duals were 1.9% (95% CI, 1.4 – 2.3) more likely to disenroll from fee-for-service to Medicare Advantage (MA). The inclusion of MA special need plans and additional benefits for those with ADRD and complex chronic conditions may be valuable for those beneficiaries with ADRD, and who may not have Medigap coverage when enrolling in fee-for-service.
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LEE, PHILIP R., and PAUL W. NEWACHECK. "Physician Reimbursement Under Medicaid." Pediatrics 89, no. 4 (April 1, 1992): 778–80. http://dx.doi.org/10.1542/peds.89.4.778.

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Physician payment under Medicaid has been a cause of growing concern among physicians because of the low levels of reimbursement in relation to private payors and the Medicare program in many states. This is particularly important to physicians caring for children because of the growing dependence of poor children on Medicaid and the evolution of Medicaid policies since the mid 1980s. Beginning in the mid 1980s Congress began legislating a series of laws that expanded Medicaid eligibility for poor and near poor children. This series of legislation culminated with the Omnibus Budget Reconciliation Acts of 1989 and 1990. These acts required all states to establish minimum Medicaid income eligibility thresholds at 133% of the federal poverty level for children less than 6 years of age and then subsequently to phase-in coverage, 1 year at a time, for all children through 18 years of age with family incomes less than 100% of poverty level.
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30

Meyer, Christian P., Christopher B. Allard, Jesse D. Sammon, Julian Hanske, Julia McNabb-Baltar, Joel E. Goldberg, Gally Reznor, et al. "The impact of Medicare eligibility on cancer screening behaviors." Preventive Medicine 85 (April 2016): 47–52. http://dx.doi.org/10.1016/j.ypmed.2015.12.019.

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31

Baker, David W., and Joseph J. Sudano. "Health Insurance Coverage During the Years Preceding Medicare Eligibility." Archives of Internal Medicine 165, no. 7 (April 11, 2005): 770. http://dx.doi.org/10.1001/archinte.165.7.770.

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32

Dillender, Marcus, and Karen Mulligan. "The Effect of Medicare Eligibility on Spousal Insurance Coverage." Health Economics 25, no. 5 (March 11, 2015): 591–605. http://dx.doi.org/10.1002/hec.3175.

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33

Moon, Marilyn, and Cori E. Uccello. "Lowering the Medicare Eligibility Age—Simple Approach, Complex Decisions." JAMA Health Forum 1, no. 6 (June 29, 2020): e200780. http://dx.doi.org/10.1001/jamahealthforum.2020.0780.

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34

Bosch, Pamela R., Amol M. Karmarkar, Indrakshi Roy, Corey R. Fehnel, Robert E. Burke, and Amit Kumar. "Association of Medicare-Medicaid Dual Eligibility and Race and Ethnicity With Ischemic Stroke Severity." JAMA Network Open 5, no. 3 (March 31, 2022): e224596. http://dx.doi.org/10.1001/jamanetworkopen.2022.4596.

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35

Caston, Nicole E., Fallon Lalor, Jaclyn Wall, Jesse Sussell, Shilpen A. Patel, Courtney Williams, Andres Azuero, Rebecca Christian Arend, Margaret Irene Liang, and Gabrielle Betty Rocque. "Associations between insurance status and the cancer clinical trial enrollment process." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 85. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.085.

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85 Background: Most patients with cancer experience multi-leveled barriers to clinical trial participation, potentially including financial concerns due to the complexity surrounding trial-related insurance coverage. Our study sought to understand the association between insurance status and cancer clinical trial eligibility, offer, and enrollment. Methods: This retrospective cohort study included patients with breast or ovarian cancer receiving a therapeutic cancer drug at the University of Alabama at Birmingham between January 2017 and February 2020. Available clinical trials and eligibility criteria were abstracted from OnCore and ClinicalTrials.gov. Patient trial eligibility, offer from provider, demographics, and clinical characteristics were abstracted from electronic medical records. Patient trial enrollment was determined via OnCore. Odds of clinical trial eligibility, offer, and enrollment by insurance status (private, public [Medicaid, Medicare]) were estimated using logistic regression models. Models estimating odds of trial offer and enrollment contained only eligible patients. Models were adjusted for patient age at diagnosis, race and ethnicity, rural-urban residence, Area Deprivation Index, cancer type, and cancer stage (early, late). Results: A total of 513 patients with breast (71%) or ovarian (29%) cancer were included in our analyses. Median age at diagnosis was 60 (interquartile range: 49-67) years; the majority were White (69%) and had early stage cancer (65%). Half of patients had private insurance (54%), and 46% of patients had public insurance (38% Medicare, 8% Medicaid). Patients with private insurance more often had early stage cancer compared to patients with public insurance (73% vs 57%). Almost two-thirds of patients (65%) were eligible for clinical trial enrollment. Of eligible patients (n = 333), 68% were offered a trial and 47% enrolled onto a trial. In adjusted analyses, patients with public vs private insurance had similar odds of clinical trial eligibility (odds ratio [OR] 0.95, 95% confidence intervals [CI] 0.61-1.48), being offered to participate (OR 1.23, 95% CI 0.71-2.14), and clinical trial enrollment (OR 1.13, 95% CI 0.68-1.89). Conclusions: Our results suggest oncologists do not assess trial eligibility or offering a trial based on insurance status, and patients do not differentially participate based on their insurance coverage. Further research is needed to understand implications of trial participation (e.g., out-of-pocket and time costs) for patients covered by differing insurance.
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36

Stype, Amanda C. "Health Insurance Patterns of Older Veterans: Evidence from the Health and Retirement Study." Journal of Risk and Financial Management 15, no. 8 (July 28, 2022): 333. http://dx.doi.org/10.3390/jrfm15080333.

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With the increased availability of community care to veterans from the VA MISSION Act, policymakers and providers need to understand how older veterans are insured, particularly before Medicare eligibility at age 65. Using data from 1996 to 2018, this study examines the insurance patterns of veterans prior to the expansion of access to community care through the VA and compares those patterns to nonveterans. This study finds that veterans are more likely to have insurance than nonveterans and that they are less likely to rely on Medicaid and Medicare before age 65. Regression estimates also suggest that veterans with at least some college education are less likely to have private insurance and are more likely to be uninsured than nonveterans with the same educational attainment.
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37

Rogers, Austin R., Sue-Min Lai, John Keighley, and Jessica Jungk. "The Incidence of Breast Cancer among Disabled Kansans with Medicare." Kansas Journal of Medicine 8, no. 3 (August 5, 2015): 93–100. http://dx.doi.org/10.17161/kjm.v8i3.11526.

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BACKGROUND: Breast cancer disparities by disability status are poorly understood. While previous studies have shown increased odds of late stage at diagnosis, it is unclear whether the incidence of breast cancer varies by disability status. METHODS: To assess cancer incidence and stage at diagnosis among disabled and nondisabled Medicare beneficiaries in Kansas, a retrospective cohort study was conducted using linked Medicare enrollment and Kansas Cancer Registry data from 2007 to 2009. Disability status was determined by the indicator for the original reason for Medicare eligibility. RESULTS: Among the 651,337 Medicare beneficiaries included in the cohort, there were 2,384 cases of breast cancer. The age-adjusted incidence was 313 per 100,000 among female beneficiaries with disabilities and 369 per 100,000 among nondisabled female beneficiaries. The adjusted incidence rate ratio was 0.93 (95% CI 0.73-1.18). When assessing stage at diagnosis, there was no difference in the odds of late stage at diagnosis by disability status (OR = 1.02; 95% CI 0.68-1.50). CONCLUSION: No significant difference in incidence or stage at diagnosis was identified among this cohort. The use of Medicare eligibility to define disability status presented a number of limitations. Future studies should seek alternate definitions of disability to assess disparities in breast cancer incidence, including definitions using Medicare claims data.
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38

Fullen, Matthew, Megan Dolbin-MacNab, Nancy Brossoie, Jonathan Wiley, and Gerard Lawson. "Denials, Surprise Charges, Starting Over: How Medicare Recipients Navigate the Medicare Mental Health Coverage Gap." Innovation in Aging 4, Supplement_1 (December 1, 2020): 94. http://dx.doi.org/10.1093/geroni/igaa057.309.

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Abstract Medicare is the primary insurance provider for approximately 51 million older adults, including those who seek mental health care. Medicare provider eligibility was last updated in 1989, and approximately one-third of the graduate-level mental health workforce (i.e., Licensed Professional Counselors and Licensed Marriage and Family Therapists) is excluded from Medicare, despite these professionals participating in Medicaid, TRICARE, the Veterans Administration, and private insurance plans. This Medicare mental health coverage gap (MMHCG) raises concerns about older adults’ access to mental health care, resulting in a policy misalignment between Medicare’s provider regulations and a growing number of older adults seeking mental health care. However, little is known about the precise impact of the MMHCG. To better understand how the MMHCG impacts older adults, we interviewed 17 Medicare-insured individuals about their experiences accessing mental health services. Using a phenomenological framework to analyze our data, we found that Medicare recipients described several consequences, such as: 1) a detrimental impact on their mental health and well-being; 2) concerns about having to start over with new providers due to commencing mental health treatment only to have services interrupted once the provider is no longer Medicare-reimbursable; and 3) relying on pro bono services from Medicare-excluded providers with uncertainty about the long-term sustainability of these arrangements. The presenters will describe how these findings fit within the current Medicare mental health service context, including the direct impact on older adults’ mental health. Discussion will also focus on policy implications of the findings and possible solutions for addressing the MMHCG.
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39

Solway, Erica, Renuka Tipirneni, and Erica Solway. "HEALTH INSURANCE AND HEALTH CARE DECISION-MAKING FOR ADULTS IN THE PRE-MEDICARE YEARS: FINDINGS FROM NATIONAL SURVEYS." Innovation in Aging 3, Supplement_1 (November 2019): S11—S12. http://dx.doi.org/10.1093/geroni/igz038.040.

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Abstract As more Americans approach retirement age and eligibility for Medicare coverage, many face difficult decisions about their health insurance and health care. This session explores how adults age 50-64 are navigating these choices following implementation of the Affordable Care Act (ACA), presenting data from two nationally representative surveys: The University of Michigan’s National Poll on Healthy Aging (NPHA) and the Health and Retirement Study (HRS). Erica Solway, Associate Director of the NPHA, will begin by presenting background information about the NPHA and an overview of critical health policy issues for adults age 50-64. Jamie Luster, Research Area Specialist at the University of Michigan, will then provide NPHA findings linking concerns about health insurance affordability with delayed/forgone health care. Next, Aaron Scherer, Associate of Internal Medicine at the University of Iowa Carver College of Medicine, will discuss NPHA findings on factors associated with adults’ concern about affordability of health insurance in retirement but before Medicare eligibility begins at age 65. Finally, Renuka Tipirneni, Assistant Professor of Internal Medicine at the University of Michigan, will present findings based on the HRS on changes in health care utilization for adults age 55-64 since implementation of the ACA’s Medicaid expansion. To conclude, Erica Solway will discuss current federal health care policy proposals for adults age 50-64, including the recent introduction of the Medicare at 50 bill, and how the perspectives and experiences of adults in this age group can help inform those policies.
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40

Minarik, Pamela A. "Health Care Financing Administration (HCFA) Instructions Clarify Medicare Reimbursement Eligibility." Clinical Nurse Specialist 8, no. 1 (January 1994): 16. http://dx.doi.org/10.1097/00002800-199401000-00006.

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41

Qin, Y., T. Young, J. Wang, Z. Thomas, C. A. Spivey, M. Chisholm-Burns, and D. K. Solomon. "Trends In Medicare Part D Medication Therapy Management Eligibility Criteria." Value in Health 17, no. 3 (May 2014): A153. http://dx.doi.org/10.1016/j.jval.2014.03.890.

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42

Frilling, Stephanie. "Medicare Telehealth Services and Nephrology: Policies for Eligibility and Payment." Advances in Chronic Kidney Disease 24, no. 1 (January 2017): 46–50. http://dx.doi.org/10.1053/j.ackd.2016.11.003.

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43

Wang, Junling, and Yanru Qiao. "Historical trend of disparity implications of Medicare MTM eligibility criteria." Research in Social and Administrative Pharmacy 9, no. 6 (November 2013): 758–69. http://dx.doi.org/10.1016/j.sapharm.2012.09.003.

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44

Lesney, Mark S. "Proposed Clinical Trial Policy Change Would Effect Medicare Pay Eligibility." Skin & Allergy News 38, no. 6 (June 2007): 80. http://dx.doi.org/10.1016/s0037-6337(07)70494-1.

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45

Davidoff, Amy J., and Richard W. Johnson. "Raising The Medicare Eligibility Age: Effects On The Young Elderly." Health Affairs 22, no. 4 (July 2003): 198–209. http://dx.doi.org/10.1377/hlthaff.22.4.198.

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46

Song, Zirui. "Potential Implications of Lowering the Medicare Eligibility Age to 60." JAMA 323, no. 24 (June 23, 2020): 2472. http://dx.doi.org/10.1001/jama.2020.7245.

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47

Arguelles, Ariel, and Meghna Sabharwal. "Health Care for All: An Overview of the Affordable Care Act’s Medicaid Expansion in the USA." Indian Journal of Public Administration 64, no. 2 (March 27, 2018): 174–92. http://dx.doi.org/10.1177/0019556117750895.

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One of the most significant health care reforms since the implementation of Medicare and Medicaid, the Affordable Care Act (ACA) enacted into law in 2010, was met with widespread criticism. The expansion of Medicaid eligibility was a specific focus of these critiques as sceptics believed the long-term effects would be primarily negative for both the physical and fiscal health of the population. This article provides a brief history of the ACA along with the role of political and public opinion. This is followed with an analysis of initial criticisms and concerns surrounding the eligibility and expansion—with a brief discussion of the constitutionality of the law. Finally, while the long-term effects of the ACA upon health care access and service in the USA are yet to be seen, preliminary results indicate positive effects, contrary to the negatives originally assumed. The article concludes with a summary of current health care reform and a prospective on the future of health care reform in the USA.
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48

Fabius, Chanee D., Portia Y. Cornell, and Kali S. Thomas. "MEDICAID FINANCING IN ASSISTED LIVING AND CHARACTERISTICS OF MEDICARE DUAL-ELIGIBLE RESIDENTS." Innovation in Aging 3, Supplement_1 (November 2019): S300. http://dx.doi.org/10.1093/geroni/igz038.1102.

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Abstract An increasing number of assisted living (AL) residents rely on Medicaid waivers or state plans to pay for personal care and other supportive services. States may finance services for duals residing in AL through Medicaid waivers and state plans, but the availability of coverage varies – some states offer little to no Medicaid coverage for services in AL, and others offer multiple pathways to receiving assistance. Little is known about duals in AL, including how many have access to AL and the quality of care they receive there. The present study compares the characteristics of Medicare beneficiaries residing in large AL settings, by dual-eligibility status, and investigates the variability in the share of duals in AL among states. We identified 586,397 Medicare beneficiaries residing in AL in 2014. Medicare claims were used to measure health characteristics and health care utilization. Duals represented 16% of AL residents in our cohort. Compared to non-duals, duals were more often older adults of color (24 vs 4%), and more likely to qualify for Medicare due to disability (46 vs 7%). Duals had higher rates of hospitalizations (24 vs 21%) and skilled nursing facility use while in AL (11 vs 10%), and more chronic conditions than non-duals. States varied in the share of AL residents who are duals, ranging from 6% in New Hampshire to 41% in New York. State policies that may contribute to variation in the prevalence of duals in AL and implications of these findings for policy-makers and residents will be discussed.
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49

Shi, Weilong, Albert Anastasio, Ndeye F. Guisse, Razan Faraj, Omolola P. Fakunle, Kirk Easley, and Kyle E. Hammond. "Impact of Insurance and Practice Type on Access to Orthopaedic Sports Medicine." Orthopaedic Journal of Sports Medicine 8, no. 7 (July 1, 2020): 232596712093369. http://dx.doi.org/10.1177/2325967120933696.

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Background: The Patient Protection Affordable Care Act has expanded Medicaid eligibility in recent years. However, the provisions of the act have not translated to improved Medicaid payments for specialists such as orthopaedic surgeons. The number of health care practitioners who accept Medicaid is already decreasing, with low reimbursement rates being cited as the primary reason for the trend. Hypothesis: Private practice orthopaedic groups will see patients with Medicaid or Medicare at lower rates than academic orthopaedic practices, and business days until appointment availability will be higher for patients with Medicaid and Medicare than those with private insurance. Study Design: Cross-sectional study. Methods: Researchers made calls to 2 regular-sized orthopaedic practices, 1 small orthopaedic practice, and 1 academic orthopaedic practice in each of the 50 states in the United States. Callers described a scenario of a recent injury resulting in a bucket-handle meniscal tear and an anterior cruciate ligament tear seen on magnetic resonance imaging at an outside emergency department. For a total of 194 practices, 3 separate telephone calls were made, each with a different insurance type. Data regarding insurance acceptance and business days until appointment were tabulated. Student t tests or analysis of variance for continuous data and χ2 or Fisher exact tests for categorical data were utilized. Results: After completing 582 telephone calls, it was determined that 31.4% (n = 59) did not accept Medicaid, compared with 2.2% (n = 4) not accepting Medicare and 1% (n = 1) not accepting private insurance ( P < .001). There was no significant association between type of practice and Medicaid refusal ( P = 0.12). Mean business days until appointment for Medicaid, Medicare, and private insurance were 5.3, 4.1, and 2.9, respectively ( P < .001). Conclusions: Access to care remains a significant burden for the Medicaid population, given a rate of Medicaid refusal of 32.2% across regular-sized orthopaedic practices. If Medicaid is accepted, time until appointment was significantly longer when compared with private insurance.
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Angel, Jacqueline L., Ronald J. Angel, and Phillip Cantu. "Medicaid Use among Older Low-Income Medicare Enrollees in California and Texas: A Tale of Two States." Journal of Health Politics, Policy and Law 44, no. 6 (August 8, 2019): 885–910. http://dx.doi.org/10.1215/03616878-7785799.

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Abstract Context: States face increasing Medicaid expenditures largely as a result of growing dual-eligible populations. In this article we examine self-reported community-based Medicaid participation among Medicare recipients 65 and older in California and Texas, with a particular focus on the older Mexican-origin population. Methods: We use six waves of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) covering the period from 1993–94 to 2010–11. Findings: The data reveal relatively high Medicaid participation rates by older individuals of Mexican origin, but significant differences between the two states. At baseline, 30% of older Mexican-origin Medicare beneficiaries in California reported receiving Medicaid compared to 41% in Texas. Conclusions: Despite California's more liberal eligibility criteria, community-dwelling Texans were more likely than Californians to report coverage at some point during the 17-year follow-up. Our data, as well as administrative data, reveal that California classifies nearly all of its community-dwelling Medicaid recipients as “full duals,” meaning that they receive full benefits, whereas Texas is more likely to classify similarly poor and disabled individuals as “partial duals,” meaning that they receive less coverage, thereby lowering overall program expenditures. Cost containment strategies that restrict access may be especially consequential for vulnerable Hispanic populations.
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