This study tests the hypothesis that delivery of Medicare-funded and Medicaidfunded services to dually eligible beneficiaries aged 65 and older via fully integrated managed care plans is associated with stronger community-based service utilization patterns compared to service delivery when Medicare- and Medicaid-funded services are delivered independently. The hope is that integrated Medicare-Medicaid managed care plans will emphasize primary care physician (PCP) visits versus specialty physician visits, reduce preventable hospital stays and emergency department (ED) visits, and enable chronically disabled elders to obtain services at home or in “assisted living” settings in preference to long-stay nursing home use–strategies that are not easily accomplished under the fragmented delivery systems of separate Medicare and Medicaid programs.
To test the hypothesis, we compare service delivery patterns among elderly dually eligible beneficiaries enrolled in two alternative managed care service delivery systems in Minnesota: Minnesota Senior Care Plus (MSC+) and the Minnesota Senior Health Option (MSHO). MSC+ is a Medicaid-only program, while MSHO is a fully integrated Medicare-Medicaid program. With few exceptions, elderly dual eligible beneficiaries in Minnesota are required to enroll in an MSC+ managed care plan for their Medicaidcovered services or, if they choose, enroll in an MSHO managed care plan that provides both Medicare-funded and Medicaid-funded services in one program. MSC+ members are assigned a case manager who helps them with their Medicaid-funded services (largely long-term care services and supports), while MSHO members are assigned a care coordinator who helps them with all of their Medicare-funded and Medicaid-funded services. MSC+ enrollees receive their Medicare-funded services through traditional fee for service Medicare or a Medicare Advantage plan, along with a Medicare Part D prescription drug plan, and must coordinate their own Medicare services.
Because dual eligibles in Minnesota can choose to enroll in MSHO rather than MSC+, and can switch between MSHO and MSC+, we examine MSHO enrollment rates and changes in MSHO enrollment over time as well as the beneficiary characteristics and community factors that are associated with the decision to enroll in MSHO. Subsequent comparisons of service use patterns across MSC+ and MSHO control for differences in beneficiary characteristics and community factors to estimate the effects of MSHO relative to MSC+ on service use patterns for similar individuals. We also explore the potential impact of unmeasured differences in the characteristics of those making a choice between the MSHO and MSC+ on the estimated differences in MSHO and MSC+ service use. Finally, we briefly describe characteristics that differentiate Medicare-only beneficiaries and dual eligibles enrolled in MSC+ and MSHO and then examine differences in their service use patterns. The study used an extensive dataset that measures beneficiary characteristics, enrollment status, and service use.
In recent years, Minnesota has increased the number of people served under MSHO while also reducing nursing home use.1 Analyses that shed light on how this has been accomplished and whether MSHO enrollment and reduced nursing home use are related may be useful to Centers for Medicare and Medicaid Services (CMS) as it partners with states to test various Medicare-Medicaid integrated care options, some as part of the Affordable Care Act implementation.
– U.S. Department of Health and Human Services Assistant Secretary for Planning and Evaluation Office of Disability, Aging and Long-Term Care Policy