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Medicare, Medicaid, and dual enrollment for adults with intellectual and developmental disabilities.Health Services Research Jun 2024Given high rates of un- and underemployment among disabled people, adults with intellectual and developmental disabilities rely on Medicaid, Medicare, or both to pay for...
OBJECTIVE
Given high rates of un- and underemployment among disabled people, adults with intellectual and developmental disabilities rely on Medicaid, Medicare, or both to pay for healthcare. Many disabled adults are Medicare eligible before the age of 65 but little is known as to why some receive Medicare services while others do not. We described the duration of Medicare enrollment for adults with intellectual and developmental disabilities in 2019 and then compared demographics by enrollment type (Medicare-only, Medicaid-only, dual-enrolled). Additionally, we examined the percent in each enrollment type by state, and differences in enrollment type for those with Down syndrome.
DATA SOURCES AND STUDY SETTING
2019 Medicare and Medicaid claims data for all adults (≥18 years) in the US with claim codes for intellectual disability, Down syndrome, or autism at any time between 2011 and 2019.
STUDY DESIGN
Administrative claims cohort.
DATA COLLECTION AND ABSTRACTION METHODS
Data were from the Transformed Medicaid Statistical Information System Analytic Files and Medicare Beneficiary Summary files.
PRINCIPLE FINDINGS
In 2019, Medicare insured 582,868 adults with identified intellectual disability, autism, or Down syndrome. Of 582,868 Medicare beneficiaries, 149,172 were Medicare only and 433,396 were dual-enrolled. Most Medicare enrollees were enrolled as child dependents (61.5%) Medicaid-only enrollees (N = 819,256) were less likely to be white non-Hispanic (58.5% white non-Hispanic vs. 72.9% white non-Hispanic in dual-enrolled), more likely to be Hispanic (19.6% Hispanic vs. 9.2% Hispanic in dual-enrolled) and were younger (mean 34.2 years vs. 50.5 years dual-enrolled).
CONCLUSION
There is heterogeneity in public insurance enrollment which is associated with state and disability type. Action is needed to ensure all are insured in the program that works for their healthcare needs.
Topics: Humans; United States; Intellectual Disability; Medicare; Medicaid; Male; Female; Developmental Disabilities; Middle Aged; Adult; Aged; Down Syndrome; Disabled Persons; Eligibility Determination; Young Adult; Insurance Claim Review
PubMed: 38264862
DOI: 10.1111/1475-6773.14287 -
The American Journal of Gastroenterology May 2024Cyclic vomiting syndrome (CVS) imposes a substantial burden, but epidemiological data are scarce. This study aimed to estimate the incidence and prevalence of CVS,...
INTRODUCTION
Cyclic vomiting syndrome (CVS) imposes a substantial burden, but epidemiological data are scarce. This study aimed to estimate the incidence and prevalence of CVS, comorbid conditions, and treatment patterns, using administrative databases in the United States.
METHODS
This cross-sectional study used claims data from Merative MarketScan Commercial/Medicare Supplemental and Medicaid databases in all health care settings. Incidence and prevalence rates for 2019 were calculated and stratified by age, sex, region, and race/ethnicity. Patient characteristics were reported among newly diagnosed patients with CVS (i.e., no documented claims for CVS before 2019). CVS was defined as having 1+ inpatient and/or 2+ outpatient CVS claims that were 7+ days apart.
RESULTS
The estimated prevalence of CVS was 16.7 (Commercial/Medicare) and 42.9 (Medicaid) per 100,000 individuals. The incidence of CVS was estimated to be 10.6 (Commercial/Medicare) and 26.6 (Medicaid) per 100,000 individuals. Both prevalence and incidence rates were higher among female individuals (for both Commercial/Medicare and Medicaid). Comorbid conditions were common and included abdominal pain (56%-64%), anxiety (32%-39%), depression (26%-34%), cardiac conditions (39%-42%), and gastroesophageal reflux disease (30%-40%). Despite a diagnosis of CVS, only 32%-35% had prescriptions for prophylactic treatment and 47%-55% for acute treatment within the first 30-day period following diagnosis.
DISCUSSION
This study provides the first population-level estimates of CVS incidence and prevalence in the United States. Comorbid conditions are common, and most patients with CVS do not receive adequate treatment. These findings underscore the need for improving disease awareness and developing better screening strategies and effective treatments.
Topics: Humans; United States; Female; Male; Vomiting; Cross-Sectional Studies; Comorbidity; Prevalence; Middle Aged; Adult; Incidence; Aged; Adolescent; Young Adult; Child; Child, Preschool; Infant; Databases, Factual; Medicare; Medicaid; Aged, 80 and over
PubMed: 38088366
DOI: 10.14309/ajg.0000000000002628 -
Health Affairs (Project Hope) Oct 2023Medicaid and the Supplemental Nutrition Assistance Program were developed during the Civil Rights era to help poor people and reduce racial and ethnic differences in...
Medicaid and the Supplemental Nutrition Assistance Program were developed during the Civil Rights era to help poor people and reduce racial and ethnic differences in health care access and food security. Although the two programs have succeeded in narrowing health and nutrition disparities, certain policies hinder goals of racial and ethnic equity, even though they do not explicitly mention race or ethnicity. These policies, including administrative policies (such as work requirements) and more basic decisions about whether to cover immigrants or expand Medicaid, can create barriers that promote racial and ethnic disparities, contrary to the programs' underlying goals.
Topics: United States; Humans; Medicaid; Ethnicity; Health Services Accessibility; Emigrants and Immigrants
PubMed: 37782872
DOI: 10.1377/hlthaff.2023.00994 -
Journal of the Academy of Nutrition and... Oct 2023Adults with mental illnesses are more likely to have low income and diet-related chronic diseases.
BACKGROUND
Adults with mental illnesses are more likely to have low income and diet-related chronic diseases.
OBJECTIVE
This study examined associations of mental illness diagnosis status with food insecurity and diet quality and whether the relationship between food security status and diet quality differed by mental illness diagnosis status in adult Medicaid beneficiaries.
DESIGN
This was a secondary cross-sectional analysis of baseline (2019-2020) data collected as part of the LiveWell study, a longitudinal study evaluating a Medicaid food and housing program.
PARTICIPANTS/SETTING
Participants were 846 adult Medicaid beneficiaries from an eastern Massachusetts health system.
MAIN OUTCOME MEASURES
Food security was measured with the 10-item US Adult Food Security survey module (0 = high food security, 1-2 = marginal food security, 3-10 = low/very low food security). Mental illness diagnoses included health record-documented anxiety, depression, or serious mental illness (eg, schizophrenia, bipolar disorder). Healthy Eating Index (HEI-2015) scores were calculated from 24-hour dietary recalls.
STATISTICAL ANALYSES
Multivariable regression analyses adjusted for demographics, income, and survey date.
RESULTS
Participants' mean (standard deviation) age was 43.1 (11.3) years, and 75% were female, 54% Hispanic, 33% non-Hispanic White, and 9% non-Hispanic Black. Fewer than half (43%) of participants reported high food security, with almost one third (32%) reporting low or very low food security. The 341 (40%) participants with one or more mental illness diagnosis had greater odds of low/very low food security (adjusted odds ratio [OR], 1.94; 95% confidence interval [CI], 1.38-2.70) and had similar mean HEI-2015 scores (53.1 vs 56.0; P = 0.12) compared with participants with no mental illness diagnosis. Mean adjusted HEI-2015 scores did not significantly differ by high vs low/very low food security for those without a mental illness diagnosis (57.9 vs 54.9; P = 0.052) or those with a mental illness diagnosis (53.0 vs 52.9; P = 0.99).
CONCLUSION
In a cohort of adults with Medicaid, those with mental illness diagnoses had higher odds of experiencing food insecurity. Overall, diet quality among adults in this sample was low but did not differ by mental illness diagnosis or food security status. These results highlight the importance of augmenting efforts to improve both food security and diet quality among all Medicaid participants.
Topics: United States; Adult; Humans; Female; Male; Longitudinal Studies; Cross-Sectional Studies; Medicaid; Food Supply; Diet; Food Insecurity
PubMed: 37207956
DOI: 10.1016/j.jand.2023.05.017 -
Medical Care Dec 2023Evaluation of Medicare-Medicaid integration models' effects on patient-centered outcomes and costs requires multiple data sources and validated processes for linkage and...
BACKGROUND
Evaluation of Medicare-Medicaid integration models' effects on patient-centered outcomes and costs requires multiple data sources and validated processes for linkage and reconciliation.
OBJECTIVE
To describe the opportunities and limitations of linking state-specific Medicaid and Centers for Medicare & Medicaid Services administrative claims data to measure patient-centered outcomes for North Carolina dual-eligible beneficiaries.
RESEARCH DESIGN
We developed systematic processes to (1) validate the beneficiary ID linkage using sex and date of birth in a beneficiary ID crosswalk, (2) verify dates of dual enrollment, and (3) reconcile Medicare-Medicaid claims data to support the development and use of patient-centered outcomes in linked data.
PARTICIPANTS
North Carolina Medicaid beneficiaries with full Medicaid benefits and concurrent Medicare enrollment (FBDE) between 2014 and 2017.
MEASURES
We identified need-based subgroups based on service use and eligibility program requirements. We calculated utilization and costs for Medicaid and Medicare, matched Medicaid claims to Medicare service categories where possible, and reported outcomes by the payer. Some services were covered only by Medicaid or Medicare, including Medicaid-only covered home and community-based services (HCBS).
RESULTS
Of 498,030 potential dual enrollees, we verified the linkage and FBDE eligibility of 425,664 (85.5%) beneficiaries, including 281,174 adults enrolled in Medicaid and Medicare fee-for-service. The most common need-based subgroups were intensive behavioral health service users (26.2%) and HCBS users (10.8%) for adults under age 65, and HCBS users (20.6%) and nursing home residents (12.4%) for adults age 65 and over. Medicaid funded 42% and 49% of spending for adults under 65 and adults 65 and older, respectively. Adults under 65 had greater behavioral health service utilization but less skilled nursing facility, HCBS, and home health utilization compared with adults 65 and older.
CONCLUSIONS
Linkage of Medicare-Medicaid data improves understanding of patient-centered outcomes among FBDE by combining Medicare-funded acute and ambulatory services with Medicaid-funded HCBS. Using linked Medicare-Medicaid data illustrates the diverse patient experience within FBDE beneficiaries, which is key to informing patient-centered outcomes, developing and evaluating integrated Medicare and Medicaid programs, and promoting health equity.
Topics: Adult; Humans; Aged; United States; Medicaid; Medicare; Home Care Services; Costs and Cost Analysis; Patient Outcome Assessment
PubMed: 37963032
DOI: 10.1097/MLR.0000000000001895 -
Intellectual and Developmental... Aug 2023Medicaid Home- and Community-Based Services (HCBS) 1915(c) waivers are the most prominent funding mechanism for the long-term services and supports (LTSS) of people with...
Medicaid Home- and Community-Based Services (HCBS) 1915(c) waivers are the most prominent funding mechanism for the long-term services and supports (LTSS) of people with intellectual and developmental disabilities (IDD). This study's aim was to conduct an in-depth national analysis of fiscal year (FY) 2021 HCBS 1915(c) waivers for people with IDD. In FY 2021, over $43.2 billion was projected for the HCBS of 861,038 people with IDD. An average of $47,315 was projected per person with IDD annually. The services that received the most funding were: residential habilitation; supports to live in one's own home; and day habilitation. HCBS is necessary so people with IDD can live and thrive in their communities.
Topics: United States; Child; Humans; Community Health Services; Home Care Services; Medicaid; Developmental Disabilities; Intellectual Disability; Long-Term Care
PubMed: 37536690
DOI: 10.1352/1934-9556-61.4.269 -
Journal of the National Cancer Institute Oct 2023Multidisciplinary cancer care (neoadjuvant chemotherapy followed by radical cystectomy or trimodality therapy) is crucial for outcome of muscle-invasive bladder cancer...
BACKGROUND
Multidisciplinary cancer care (neoadjuvant chemotherapy followed by radical cystectomy or trimodality therapy) is crucial for outcome of muscle-invasive bladder cancer (MIBC), a potentially curable illness. Medicaid expansion through Affordable Care Act (ACA) increased insurance coverage especially among patients of racial minorities. This study aims to investigate the association between Medicaid expansion and racial disparity in timely treatment in MIBC.
METHODS
This quasi-experimental study analyzed Black and White individuals aged 18-64 years with stage II and III bladder cancer treated with neoadjuvant chemotherapy followed by radical cystectomy or trimodality therapy from National Cancer Database 2008-2018. Primary outcome was timely treatment started within 45 days following cancer diagnosis. Racial disparity is the percentage-point difference between Black and White patients. Patients in expansion and nonexpansion states were compared using difference-in-differences and difference-in-difference-in-differences analyses, controlling for age, sex, area-level income, clinical stage, comorbidity, metropolitan status, treatment type, and year of diagnosis.
RESULTS
The study included 4991 (92.3% White, n = 4605; 7.7% Black, n = 386) patients. Percentage of Black patients who received timely care increased following the ACA in Medicaid expansion states (54.5% pre-ACA vs 57.4% post-ACA) but decreased in nonexpansion states (69.9% pre-ACA vs 53.7% post-ACA). After adjusting covariates, Medicaid expansion was associated with a net 13.7 percentage-point reduction of Black-White patient disparity in timely receipt of MIBC treatment (95% confidence interval = 0.5% to 26.8%; P < .01).
CONCLUSIONS
Medicaid expansion was associated with statically significant reduction in racial disparity between Black and White patients in timely multidisciplinary treatment for MIBC.
Topics: United States; Humans; Medicaid; Patient Protection and Affordable Care Act; Urinary Bladder Neoplasms; Racial Groups; Insurance Coverage; Muscles
PubMed: 37314971
DOI: 10.1093/jnci/djad112 -
Telemedicine Journal and E-health : the... Jun 2024
Topics: Humans; Hypertension; COVID-19; Medicaid; Telemedicine; United States; Female; Male; Middle Aged; Rural Population; SARS-CoV-2; Aged; New Hampshire; Adult; Primary Health Care; Pandemics; Poverty
PubMed: 38457122
DOI: 10.1089/tmj.2023.0628 -
Value in Health : the Journal of the... Dec 2023
Section 50 of the Inflation Reduction Act Drug Price Negotiation Program: Considerations for the Centers for Medicare & Medicaid Services, Manufacturers, and the Health Economics and Outcomes Research Community.
Topics: Aged; Humans; United States; Medicare; Medicaid; Negotiating; Economics, Medical; Inflation, Economic
PubMed: 37827492
DOI: 10.1016/j.jval.2023.09.2995 -
Pediatrics Nov 2023The American Academy of Pediatrics envisions a child and adolescent health care system that provides individualized, family-centered, equitable, and comprehensive care...
The American Academy of Pediatrics envisions a child and adolescent health care system that provides individualized, family-centered, equitable, and comprehensive care that integrates with community resources to help each child and family achieve optimal growth, development, and well-being. All infants, children, adolescents, and young adults should have access to this system. Medicaid and the Children's Health Insurance Program (CHIP) provide critical support and foundation for this vision. Together, the programs currently serve about half of all children, many of whom are members of racial and ethnic minoritized populations or have complex medical conditions. Medicaid and CHIP have greatly improved the health and well-being of US infants, children, adolescents, and young adults. This statement reviews key program aspects and proposes both program reforms and enhancements to support a higher-quality, more comprehensive, family-oriented, and equitable system of care that increases access to services, reduces disparities, and improves health outcomes into adulthood. This statement recommends foundational changes in Medicaid and CHIP that can improve child health, achieve greater equity in health and health care, further dismantle structural racism within the programs, and reduce major state-by-state variations. The recommendations focus on (1) eligibility and duration of coverage; (2) standardization of covered services and quality of care; and (3) program financing and payment. In addition to proposed foundational changes in the Medicaid and CHIP program structure, the statement indicates stepwise, coordinated actions that regulation from the Centers for Medicare and Medicaid Services or federal legislation can accomplish in the shorter term. A separate technical report will address the origins and intents of the Medicaid and CHIP programs; the current state of the program including variations across states and payment structures; Medicaid for special populations; program innovations and waivers; and special Medicaid coverage and initiatives.
Topics: Aged; Infant; Adolescent; Child; Young Adult; Humans; United States; Medicaid; Child Health; Child Health Services; Medicare; Insurance, Health; Children's Health Insurance Program; Insurance Coverage
PubMed: 37860840
DOI: 10.1542/peds.2023-064088