Abstract

Background: Integrating care for low-income older adults in the United States is challenging because two separate government insurance programs provide benefits: Medicare covers medical needs and Medicaid covers long-term services and supports. The state of Tennessee, which provides Medicaid benefits through private managed care plans, implemented a new approach to addressing this issue by modifying its contracting requirements for Medicaid insurers. In 2013, Tennessee announced that all insurers who provide Medicaid benefits would be required to offer a separate Medicare managed care plan by 2015 that specialized in meeting the needs of individuals who receive both Medicare and Medicaid (known as “dual-eligible beneficiaries”). This policy change was based on the premise that if the same insurer provides Medicare and Medicaid benefits (even if these benefits are provided through separate plans) , then there may be enhanced opportunities for care coordination and more efficient management of health care services.

Objectives: Using individual-level Medicare, Medicaid, and hospital discharge data, this study examines whether dual-eligible beneficiaries who joined aligned Medicare and Medicaid plans had changes in their use of health care services relative to dual-eligible beneficiaries who were not in aligned plans. The analysis leverages the fact that Medicaid managed care plans varied in how quickly they began offering aligned plan options.

Results: This change increased the availability of aligned Medicare and Medicaid benefits for approximately 145,000 dual-eligible beneficiaries in Tennessee. The number of beneficiaries enrolled in Medicare plans operated by Tennessee Medicaid insurers almost tripled between 2011 and 2016.

Outcomes include any use of medical services (hospital and emergency room use) or long-term services and supports (home-and-community-based services and institutional nursing home care), as well as intensity of use for these services.

Conclusions: The study results will provide policymakers with evidence on whether this aligned care model changed health care delivery in ways that may have improved quality for dual-eligible beneficiaries and advanced efficient service use.