Association Of State Policies With Medicaid Disenrollment Among Low-Income Medicare Beneficiaries

Abstract

For some low-income Medicare beneficiaries, Medicaid provides financial protection against Medicare's out-of-pocket costs, but many Medicare beneficiaries who qualify for Medicaid are not continuously enrolled. We examined Medicaid disenrollment among fee-for-service Medicare beneficiaries and the relationship between disenrollment and state policies. In the period 2012-16, 18.2 percent of Medicare beneficiaries who received full or partial Medicaid disenrolled for reasons other than death. More than 50 percent of Medicare beneficiaries who remained without Medicaid one year after disenrolling continued to receive low-income subsidies for Medicare Part D coverage with eligibility requirements similar to those of Medicaid. Among Medicare beneficiaries with continuous Part D subsidies, the rate of Medicaid disenrollment was 24 percent lower in states that automatically enrolled recipients of the federal Supplemental Security Income program in full Medicaid, 33 percent lower in states with more generous provider payment policies, and 37 percent lower in states with less restrictive asset limits for partial Medicaid. Policies that make it easier for people to maintain Medicaid eligibility and that enhance access to care in Medicaid via higher provider reimbursements may reduce disenrollment.

Keywords: Dual Eligibles; Medicaid; Medicare.

Exhibit 3:. Proportion of Medicare beneficiaries who continued to receive the Part D Low-Income Subsidy after disenrolling from Medicaid

Source: Source: Authors’ analysis of Part D Low-Income Subsidy data from Medicare Master Beneficiary Summary Files for the period 2012–16. Notes: Proportion of Medicare beneficiaries who received the full vs. partial Part D Low-Income Subsidy following disenrollment from full or partial Medicaid (i.e., a loss of Medicaid altogether), excluding beneficiaries who moved states, person-months in which a beneficiary subsequently regained Medicaid, and months after a beneficiary died or exited fee-for-service Medicare. On the horizontal axis, month 0 corresponds to the month in which Medicaid coverage was initially lost. The sample size in month 0 is 91,943 Medicare beneficiaries, and is smaller in subsequent months due to re-enrollment in Medicaid and censoring due to death, end of the study period, or beneficiaries’ exit from fee-for-service Medicare.