Medicare Beneficiaries Covered by Medicaid Buy-In Agreements

Health Affairs

Volumn 16, Issue 1, 1997, Pages 175-184

  Merrell, Katie ^a   Colby, David C ^a   Hogan, Christopher ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ADULT; AGED; ARTICLE; COST; HEALTH CARE DELIVERY; HEALTH SERVICE; HEALTH STATUS; HUMAN; INFORMATION PROCESSING; INSURANCE; MEDICAID; MEDICARE; MIDDLE AGED; POVERTY; STATISTICS; UNITED STATES; UTILIZATION REVIEW;

ADULT; AGED; COST SHARING; DATA COLLECTION; HEALTH SERVICES; HEALTH SERVICES ACCESSIBILITY; HEALTH STATUS; HUMANS; INSURANCE COVERAGE; MEDICAID; MEDICARE; MIDDLE AGED; POVERTY; UNITED STATES;

EID: 0347799661     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.16.1.175     Document Type: Article

References (14)

1. Others who receive Medicaid assistance, such as residents of Puerto Rico (which does not have a buy-in agreement) and some persons who pay their own Part B premiums, are not included in this analysis, which is based on administrative data about buy-in coverage.
2. Qualified disabled and working individuals (QDWIs) are not discussed here. These disabled persons would lose Part A coverage if they returned to work but are not eligible for Medicaid. States are required to pay the Part A premiums of these persons if their incomes and resources are below set standards.
3. The MCBS, which began in 1991, is a longitudinal survey of about 12,000 Medicare beneficiaries sponsored by the Health Care Financing Administration (HCFA) Office of the Actuary. The data analyzed below are from the survey fielded in September through December 1993, reporting experiences for that year. All standard errors have been adjusted for the effect of the sample design. For previous analyses of the MCBS, see M.L. Rosenbach, K.W. Adamache, and R.K. Khandker, "Variations in Medicare Access and Satisfaction by Health Status, 1991-93," Health Care Financing Review (Winter 1995): 29-49; and G.S. Adler, "Medicare Beneficiaries Rate Their Medical Care: New Data from the MCBS," Health Care Financing Review (Summer 1995): 175-187.
4. The MCBS, which began in 1991, is a longitudinal survey of about 12,000 Medicare beneficiaries sponsored by the Health Care Financing Administration (HCFA) Office of the Actuary. The data analyzed below are from the survey fielded in September through December 1993, reporting experiences for that year. All standard errors have been adjusted for the effect of the sample design. For previous analyses of the MCBS, see M.L. Rosenbach, K.W. Adamache, and R.K. Khandker, "Variations in Medicare Access and Satisfaction by Health Status, 1991-93," Health Care Financing Review (Winter 1995): 29-49; and G.S. Adler, "Medicare Beneficiaries Rate Their Medical Care: New Data from the MCBS," Health Care Financing Review (Summer 1995): 175-187.
5. These rates are for stays reported through Medicare claims. They may misstate hospitalization and SNF rates to the extent that private payers, Medicaid, or other government programs paid for an episode of care for which no Medicare claim was submitted.
6. Because of space limitations, rates are reported here for one-third of the indicators analyzed. Those presented were chosen because they relate to fairly prevalent conditions and either are based on very specific types of care or are broadly accepted indicators of appropriate care. The rates for all indicators for the Medicaid and non-Medicaid groups are available from the authors. See Physician Payment Review Commission, Monitoring Access of Medicare Beneficiaries, Report 95-1 (Washington: PPRC, 1995) for more information about the development and measurement of these indicators.
7. One set of indicators for which the Medicaid group had consistently higher rates than the non-Medicaid group is not reported here. The Medicaid group scored higher on nonspecific indicators based on the presence of a visit long after a particular event, which may be attributable to their worse health status and higher overall visit rate rather than to receipt of specific follow-up care.
8. J.L. Walker, "The Diffusion of Innovations among the American States," American Political Science Review (September 1969): 880-899.
9. Advisory Commission on Intergovernmental Relations, Public Assistance: The Growth of a Federal Function (Washington: U.S. Government Printing Office, 1980).
10. R.E. Dawson and V. Gray, "State Welfare Policies," in Politics in the American States, ed. H. Jacob and K.N. Vines (Boston: Little Brown and Co., 1971), 433-476.
11. R.H. Brook et al., "Does Free Care Improve Adults' Health?" The New England Journal of Medicine (8 December 1983): 1426-1434; and E.B. Keeler et al., "Effects of Cost Sharing on Physiological Health, Health Practices, and Worry," Health Services Research (August 1987): 279-305.
12. R.H. Brook et al., "Does Free Care Improve Adults' Health?" The New England Journal of Medicine (8 December 1983): 1426-1434; and E.B. Keeler et al., "Effects of Cost Sharing on Physiological Health, Health Practices, and Worry," Health Services Research (August 1987): 279-305.
13. K. Lohr et al., "Use of Medical Care in the RAND Health Insurance Experiment: Diagnosis and Service-Specific Analyses in a Randomized Controlled Trial," Medical Care (Supplement 1986): S31-S38.
14. T. Rice, E.R. Brown, and R. Wyn, "Holes in the Jackson Hole Approach to Health Care Reform," Journal of the American Medical Association (15 September 1993): 1357-1362.