Shinu Verghese

National and state trends in enrollment and spending for dual eligibles under age 65 in Medicaid managed care

BACKGROUND To reduce costs and improve care, states are increasingly enrolling individuals with disabilities in Medicaid managed care. Many states allow or require adults who are dually eligible for Medicaid and Medicare to enroll in these plans. OBJECTIVE This study (1) quantifies changes in enrollment by managed care arrangement for duals under age 65, between 2005 and 2008 and (2) compares enrollment and spending between dual eligibles and Medicaid-only beneficiaries. METHODS We used Medicaid Analytic eXtract data to compare the Medicaid enrollment and spending for all-year, full-benefit dual eligibles ages 21-64 with that of Medicaid-only Supplemental Security Income (SSI) and disabled beneficiaries. The study population was classified into 9 types of managed care to quantify enrollment and calculate expenditures by year. RESULTS Nationwide, the proportion of adult duals in managed care increased from 2005 to 2008, with the expansion of prepaid health plans (PHPs) (31.0%-46.6%), particularly behavioral health PHPs, driving the increase. In 2008, Medicaid-only disabled adults were three times as likely as dual adults to enroll in comprehensive managed care (CMC) (35.1% versus 11.7%). Average Medicaid expenditures per enrollee differed markedly by managed care arrangement and state. CONCLUSIONS From 2005 to 2008, there was little expansion of CMC among adult duals, while the use of PHPs to cover carved out services increased greatly. New federal initiatives aim to reduce barriers to enrolling duals into comprehensive, integrated managed care. With expanded enrollment, it will be important to monitor enrollment and evaluate whether integration improves care.

Migration patterns for Medicaid enrollees 2005-2007.

BACKGROUND Although Medicaid is a federal program, it is administered primarily by the states. Enrollees move from state to state, but their migration patterns have remained largely unknown. There are concerns about the possibility of enrollment gaps, lack of health insurance coverage, breaks in continuity of care, unmet need, risks to health status, and increased system-wide costs due to uncompensated care and the use of higher cost emergency room services because of enrollment gaps. There is also concern about the extent to which people enrolled in more than one state are double counted. OBJECTIVE To examine the migration of Medicaid enrollees across states. METHODS We use 2005-2007 Medicaid enrollment records that were unduplicated and linked across states and over the study period. We report descriptive statistics on enrollee migration across states. RESULTS Among all enrollees, 3.7 percent moved to another state at least once and most moved only once. Overall, 72.2 percent of moves did not result in an enrollment gap, whereas 8.2 percent of moves resulted in gaps of fewer than three months, and 11.4 percent of moves resulted in gaps of more than six months. CONCLUSIONS These initial findings provide a context for further examining the consequences of enrollee moves on their health and on program expenditures. The consequences of enrollment gaps will become increasingly important as the Medicaid population grows under the provisions of the Affordable Care Act.