Comparing Care for Dual-Eligibles across Coverage Models: Empirical Evidence from Oregon

Hyunjee Kim
Christina J Charlesworth
K John McConnell
Jennifer B Valentine
David C Grabowski
Peer-Reviewed Article
November 2017

Individuals who are eligible for both Medicare and Medicaid are enrolled in many different types of coverage with varying levels of coordination across their Medicare and Medicaid benefits. Very little data exists comparing the characteristics and outcomes of dually eligible enrollees in different coverage models, ranging from Medicare and Medicaid fee-for-service, or managed care options like Medicare Advantage or Medicaid managed care. Notably, for Medicaid managed care plans that offer a Dual Eligible Special Needs Plan, members may join “aligned” plans where a single insurance company administers both Medicare or Medicaid benefits and bears risk for both programs. Conversely, in “unaligned” plans, these benefits are administered by separate companies. By analyzing data from Oregon, this study found that different combinations of fee-for-service and managed care can affect the care that dually eligible individuals receive, and that increased incentives for financial alignment across Medicare and Medicaid plans led to improvement in care.

Dually eligible individuals enrolled in Medicare Advantage and Medicaid fee-for-service experienced generally worse quality of care than those enrolled in other coverage models. Enrollees with aligned Medicare Advantage and Medicaid managed care plans experienced improved outcomes related to utilization of services and quality of care. In developing policies that affect dually eligible individuals, identifying the variation and effectiveness of coverage models is important in order to better address the needs of the population being served.

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