Effect of Long-term Care Use on Medicare and Medicaid Expenditures for Dual Eligible and Non-dual Eligible Elderly Beneficiaries

Abstract

Results: Among dual eligibles and non-dual eligibles, the average number of diseases and case mix scores are higher for LTC users. Adjusting for case mix virtually eliminates the difference for medical costs, but not for LTC expenditures. Adjusting for LTC status reduces the difference in LTC costs, but increases the difference in medical costs. Conclusions:Efforts to control costs for dual eligibles should target those in LTC while better coordinating medical and LTC expenditures. Access, Demand Uninsured, 2011Uninsured, , 2012 Kane, Homyak, Parashuram, Lee, & Woodhouse, 2008; Kasper, Watts, & Lyons, 2010; Young, Garfield, Musumeci, Clemens-Cope, Lawton, 2012). However, the data are mainly descriptive and do not account for the role of casemix or other characteristics. One explanation for disproportionate costs is that double program coverage results in overlaps and inefficiencies, leading to proposed solutions such as integrated care (Gold, Jacobson, & Garfield, 2012;Meyer, 2012;Neuman, Lyons, Rentas, & Rowland, 2012). There is a clear need to identify the specific characteristics of Medicare-Medicaid enrollees that account for their disproportionately high expenditures for medical and long-term care. Keywords:The only study to examine the effect of casemix on Medicare-Medicaid enrollees' higher LTC costs found that they were largely attributable to greater levels of dysfunction and disease burden (Liu, Long, & Aragon, 1998). Our study builds upon this work with more recent data and a separate examination of the role of LTC care setting and case mix for elderly MedicaidMedicare beneficiaries. We analyzed Medicare and Medicaid data to examine how type of long-term care and case mix affect expenditures towards medical care and LTC for older MedicareMedicaid enrollees and non-duals, and how these expenditures vary between programs and settings. In response to the findings of Bubolz, Emerson, and Skinner (2012), we also looked for evidence of de facto cross-subsidization among those covered by both Medicare and Medicaid; namely, was nursing home use (covered only by Medicaid) associated with lower medical care use (covered by Medicare)? Methods Study PopulationOur study population consists of individuals aged 65 years and older in 2005, enrolled in (1) Medicaid only, (2) Medicare only, and (3) Medicare and Medicaid simultaneously. We selected residents from seven states (Arkansas, Florida, Minnesota, New Mexico, Texas, Vermont, and Washington) who illustrate diverse management techniques across the target populations, and diverse state characteristics; e.g., demographics, size, geography, structure of county government, and policies. The LTC waiver, state plan programs, and plan variations are summarized in Appendix Exhibit A1. All of the states had an aging and disability waiver.In order to analyze the characteristics and expenditures of duals and non-dual beneficiaries based on LTC utilization, we classified our study sample into four groups based on program enrollment and LTC use: MMRR 2013: Volume 3 ...

Health Care Expenditures After Initiating Long-term Services and Supports in the Community Versus in a Nursing Facility

“…Unlike the findings of Wysocki et al 9 and Kane et al, 10 we did not find that the higher cost for LTSS provided in nursing facilities was fully offset by lower acute and postacute spending when compared with those receiving LTSS in the community. However, we did observe in our multivariate analysis that older age and cognitive limitations were associated with higher LTSS spending and lower acute and postacute expenditures.…”

“…8 However, others have found that nursing facility care may be offset by lower spending in acute and postacute settings, especially among individuals with complex health needs. 9,10 In the current study, we attempted to unravel the contribution of individual health factors from delivery system factors to determine the source of expenses for California MMEs who initiated either extended nursing facility care or HCBS. We applied propensity score methods to construct samples of MMEs with similar levels of need using each type of LTSS.…”

Evaluating the Effectiveness of a Nurse Practitioner-Led Outreach Program for Long-Term-Care Homes

“…A possible explanation for this finding is that RNs may not be equipped with the assessment and treatment skills or practice jurisdiction necessary to independently treat certain health conditions, and thus opt to transfer them to the ED. While our findings support the argument that the use of NPs in LTC homes reduces the need for acute care and ED services (Kane, Keckhafer, Flood, Bershadsky, & Siadaty, 2003;Klaasen et al, 2009), we believe that our study is unique in that it is likely the first to compare ED transfer across NPs, MDs, and RNs using adjusted GEE analyses.…”

The Long View of Long‐Term Care: Our Personal Take on Progress, Pitfalls, and Possibilities

“…Beginning in 2001, the Centers for Medicare and Medicaid Services (CMS) awarded states and other organizations with Real Choice System Changes grants to encourage the infrastructure needed to support HCBS by creating a capacity for personal attendant services, developing NH transition programs, establishing Aging and Disability Resource Centers to provide better information for consumers, and developing quality management in HCBS. From 2003 to 2005, with CMS funding, we used mixed methods to study the rebalancing experience in eight states …”

“…From 2003 to 2005, with CMS funding, we used mixed methods to study the rebalancing experience in eight states. 40 We have consistently tried to advance quality. From 1998 to 2002, under a CMS contract, we developed and tested measures of NHs residents' QOL, collecting the data directly from residents-even those with substantial cognitive impairment.…”