Racial/Ethnic Disparities in Medicare Advantage vs. Traditional Medicare: Evidence to Improve Equity in Medicare

医疗保险优势与传统医疗保险的种族/民族差异：改善医疗保险公平性的证据

• 批准号: 10836898
• 负责人: Eric T Roberts
• 金额: $ 13.34万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-15 至 2027-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10836898
• 关键词: Accounting; Admission activity; Adult; Adverse effects; Affect; Alzheimer' s Disease; Alzheimer' s disease related dementia; Ambulatory Care; Awareness; Black race; COVID-19; Caring; Chronic; Complex; Contracts; Cost Sharing; Data; Dental; Diagnosis; Disabled Persons; Discrimination; Disparity; Elderly; Eligibility Determination; Enrollment; Equity; Ethnic Origin; Face; Future; Grant; Hazard Models; Health; Health Insurance; Health Services Accessibility; Health Status; Healthcare; Heterogeneity; Hispanic; Hospitalization; Impaired cognition; Income; Individual; Insurance; Interruption; Link; Long-Term Care; Low income; Medicaid; Medicaid eligibility; Medicare; Medicare/Medicaid; Outcome; Outpatients; Parents; Patient Self-Report; Periodicals; Persons; Pharmaceutical Preparations; Policies; Procedures; Process; Race; Reporting; Research; Risk; Role; Sampling; Self Assessment; Services; Supplemental Security Income; Surveys; Testing; Time; Variant; Visit; Work; adult of color; barrier to care; beneficiary; cost; demographics; dual eligible; ethnic disparity; experience; field survey; hazard; health care disparity; improved; outcome disparities; programs; public health emergency; racial disparity

PROJECT SUMMARY / ABSTRACT In April 2023, states began to unwind provisions of the COVID-19 public health emergency that enabled people to remain continuously enrolled in Medicaid without completing periodic eligibility redeterminations. States are now required to re-evaluate eligibility for all Medicaid beneficiaries within 14 months. This change is beginning to affect 12.2 million low-income older adults and disabled individuals with Medicare and Medicaid, known as dual eligibles, who rely on Medicaid supplemental insurance for help paying Medicare premiums, cost sharing, and for some, services such as dental and long-term care. To maintain Medicaid coverage, older adult duals need to complete a complex redetermination process, accounting for programs with distinct eligibility rules, each of which requires detailed proof of income and assets. The complexity of the redetermination process raises concerns that older adults may experience abrupt changes in Medicaid or lose this coverage altogether. Prior studies, including those by our team, highlight the potential for loss of Medicaid supplemental insurance and variation in its effects according to individuals’ Medicare coverage (e.g., Medicare Advantage vs. traditional Medicare), health diagnoses (e.g., Alzheimer’s disease), and race/ethnicity. The extent of Medicaid loss may also vary based on state policies that simplify or automate Medicaid redeterminations. In this supplement to NIA grant R01AG076437, we propose to leverage national Medicare administrative data (which reports monthly Medicaid enrollment) and a soon-to-be-fielded survey under our parent R01 to examine individual-, Medicare plan- and policy-level determinants of Medicaid loss among older adults, assess older adults’ experiences with redeterminations, and identify racial and ethnic disparities in these outcomes. We will also examine the effects of Medicaid loss on health care use and disparities, focusing on outpatient visits and medication filling (sensitive to cost sharing in Medicare) and preventable hospitalizations (which may reflect adverse health outcomes). This supplement builds on our parent R01, which examines racial and ethnic health care disparities among older adults in Medicare Advantage vs. traditional Medicare, in three ways. First, we examine how changes in Medicaid coverage moderate racial and ethnic health care disparities among older adult Medicare beneficiaries. Second, we examine the role of factors at Medicare plan and state policy levels in mitigating Medicaid coverage loss and its effects on health care use and disparities. Third, we capitalize on a planned survey of Medicare beneficiaries for our parent R01, and include an additional sample of low-income older adults, to assess self-reported experiences navigating Medicaid redeterminations. By providing timely evidence about the effects of Medicaid redeterminations on low-income older adults, our research can guide future reforms to improve the continuity of Medicaid supplemental coverage and promote equitable care for low-income older adult Medicare beneficiaries.

项目概要/摘要 2023 年 4 月，各州开始放松针对 COVID-19 公共卫生紧急事件的规定，这些规定使人们能够 继续参加医疗补助而无需完成资格重新确定的州。 现在需要在 14 个月内重新评估所有医疗补助受益人的资格。这一变化即将开始。 影响 1220 万低收入老年人和残疾人的医疗保险和医疗补助，称为 双重资格，依靠医疗补助补充保险来帮助支付医疗保险保费、费用分摊、 对于某些人来说，牙科和长期护理等服务为了维持医疗补助覆盖范围，老年人需要双重服务。 需要完成复杂的重新确定过程，考虑具有不同资格规则的项目， 每一项都需要详细的收入和资产证明 重新确定过程的复杂性。 令人担忧的是，老年人可能会经历医疗补助的突然变化或完全失去这一覆盖范围。 之前的研究（包括我们团队的研究）强调了失去医疗补助补充保险的可能性 以及根据个人的医疗保险覆盖范围（例如，医疗保险优势与医疗保险优惠）其影响的变化。 传统医疗保险）、健康诊断（例如阿尔茨海默病）和种族/民族医疗补助范围。 损失也可能根据简化或自动化医疗补助重新确定的州政策而有所不同。 作为 NIA 拨款 R01AG076437 的补充，我们建议利用国家医疗保险管理数据（其中 报告每月医疗补助登记情况）以及我们母公司 R01 下即将进行的调查以检查 老年人医疗补助损失的个人、医疗保险计划和政策层面的决定因素，评估了老年人 我们将了解成年人的重新决定经历，并确定这些结果中的种族和民族差异。 还研究了医疗补助损失对医疗保健使用和差异的影响，重点关注门诊就诊和 药物配药（对医疗保险费用分摊敏感）和可预防的住院治疗（这可能反映 该补充品以我们的母体 R01 为基础，该补充品检查种族和民族健康状况。 Medicare Advantage 与传统 Medicare 中老年人的护理差异主要体现在三个方面。 研究医疗补助覆盖范围的变化如何缓和老年人之间的种族和民族医疗保健差异 其次，我们研究了医疗保险计划和国家政策层面因素的作用。 减轻医疗补助覆盖范围的损失及其对医疗保健使用和差异的影响第三，我们利用 计划对我们母公司 R01 的 Medicare 受益人进行调查，并包括低收入的额外样本 老年人，通过及时提供评估自我报告的医疗补助重新确定经历。 关于医疗补助终止对低收入老年人影响的证据，我们的研究可以指导 未来的改革旨在提高医疗补助补充覆盖的连续性并促进公平护理 低收入老年人医疗保险受益人。