Employee Benefits and Frailty in Mexican Community-Dwelling Older Adults (original) (raw)
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Health Affairs
In 2014 California implemented a demonstration project called Cal MediConnect, which used managed care organizations to integrate Medicare and Medicaid, including long-term services and supports for beneficiaries dually eligible for Medicare and Medicaid. Postenrollment telephone surveys assessed how enrollees adjusted to Cal MediConnect over time. Results showed increased satisfaction with benefits, improved ratings of quality of care, fewer acute care visits, and increased personal care assistance hours over time. Enrollees also had somewhat better prescription medication access and lower unmet needs for personal care, compared to the comparison group. The lack of improvement in care coordination raises concerns about the implementation of the care coordination benefit, a key feature of the program. The Bipartisan Budget Act of 2018 contains provisions that permanently certify the use of managed care (such as Dual Eligible Special Needs Plans) to integrate Medicare and Medicaid, which makes the lessons learned from California's duals demonstration especially relevant for informing other integrated programs for seniors and people with disabilities.
BMC Geriatrics, 2020
Background Little is known regarding the impact of transitions in frailty on healthcare use and payment in older Mexican Americans. We address this gap in knowledge by investigating the effect of early transitions in physical frailty on the use of healthcare services and Medicare payments involving older Mexican Americans. Methods Longitudinal analyses were conducted using the Hispanic Established Populations for the Epidemiological Study of the Elderly (Hispanic-EPESE) survey data from five Southwest states linked to the Medicare claims files from the Centers for Medicare and Medicaid Services. Seven hundred and eighty-eight community-dwelling Mexican Americans 72 years and older in 2000/01 were studied. We used a modified Frailty Phenotype (unintentional weight loss, weakness, self-reported exhaustion and slow walking speed) to classify frailty status (non-frail, pre-frail or frail). Each participant was placed into one of 5 frailty transition groups: 1) remain non-frail, 2) remai...
Issue brief (Commonwealth Fund), 2016
Issue: Two-thirds of Medicare beneficiaries with physical and/or cognitive impairment (PCI) who live in the community have three or more chronic conditions and could benefit from integrated medical and social services. Over one-third of those with PCI have incomes under 200 percent of the federal poverty level but are not covered by Medicaid, exposing them to risk of financial burdens and nursing home placement. Goal: To analyze two policy options that expand financing for home- and community-based care for older adults with PCI. Methods: Potential costs are estimated using the Medicare Current Beneficiary Survey. Key findings and conclusions: Medicare Help at Home—a proposal to add supplemental home- and community-based services—could be financed by income-related cost-sharing, beneficiary monthly premiums of 42,andanincrementalpayrolltaxonemployersandemployeesof0.4percent.ThiscouldproducesavingstoMedicaidof42, and an incremental payroll tax on employers and employees of 0.4 percent. This could produce savings to Medicaid of 42,andanincrementalpayrolltaxonemployersandemployeesof0.4percent.ThiscouldproducesavingstoMedicaidof1.6 billion over 14 years. Using a different option—a...
BMJ Open, 2015
Objectives: While the benefits of Seguro Popular health insurance in Mexico relative to no insurance have been widely documented, little has been reported on its effects relative to the pre-existing Social Security health insurance. We analyse the effects of Social Security and Seguro Popular health insurances in Mexico on access to healthcare of older adults, and on financial risk protection to their households, compared with older adults without health insurance. Setting: Secondary data analysis was performed using the 2012 Mexican Survey of Health and Nutrition (ENSANUT). Participants: The study population comprised 18 847 older adults and 13 180 households that have an elderly member. Outcome measures: The dependent variables were access to healthcare given the reported need, the financial burden imposed by health expenditures measured through catastrophic health-related expenditures, and using savings for health-related expenditures. Separate propensity score matching analyses were conducted for each comparison. The analysis for access was performed at the individual level, and the analysis for financial burden at the household level. In each case, matching on a wide set of relevant characteristics was achieved. Results: Seguro Popular showed a protective effect against lack of access to healthcare for older adults compared with those with no insurance. The average treatment effect on the treated (ATET) was ascertained through using the nearest-neighbour matching (−8.1%, t-stat −2.305) analysis. However, Seguro Popular did not show a protective effect against catastrophic expenditures in a household where an older adult lived. Social Security showed increased access to healthcare (ATET −11.3%, t-stat −3.138), and protective effect against catastrophic expenditures for households with an elderly member (ATET −1.9%, t-stat −2.178). Conclusions: Seguro Popular increased access to healthcare for Mexican older adults. Social Security showed a significant protective effect against lack of access and catastrophic expenditures compared with those without health insurance.
Kaiser/Commonwealth Fund 1997 Survey of Medicare Beneficiaries
Central to the debate on Medicare's future are the health care needs of the millions of elderly and disabled Americans who depend on the program for basic health insurance coverage. As the National Bipartisan Commission on the Future of Medicare considers Medicare's role into the next century, a key challenge will be how to maintain or improve access to health care in the event of illness. Today, Medicare insures 34 million elderly Americans as well as 5 million permanently disabled beneficiaries under age 65. This population is generally at high risk for acute and chronic illness and has diverse health care needs and experiences. To profile beneficiaries' experiences getting health care, examine their exposure to financial burden, and analyze how their experiences vary by income level, health status, and insurance coverage, The Commonwealth Fund and The Henry J. Kaiser Family Foundation jointly supported the Kaiser/Commonwealth 1997 Survey of Medicare Beneficiaries. The survey, which included telephone interviews with 3,300 non-institutionalized Medicare enrollees, was conducted by Louis Harris and Associates, Inc., from November 1996 through June 1997. Beneficiaries reported on their health care access and costs, their supplemental insurance coverage, and their decision of whether to join a Medicare health maintenance organization (HMO). 1 The survey's findings underscore the diversity of the Medicare population and point to the challenge of improving protections for the relatively large share of beneficiaries with low incomes and/or health problems. SUMMARY OF FINDINGS Portrait of the Medicare Population Overall, the survey's findings portray a population at high risk owing to problematic health and low or modest incomes. Contrary to popular media images of the wealthy and healthy retiree, two of three Medicare beneficiaries live on relatively low incomes or have health problems. One of three beneficiaries lives on an income below 200 percent of the poverty level (about $15,000 annually for an individual) and reports health problems. Half (49%) said they spend all (22%) or most (27%) of their monthly income on basic living necessities. Beneficiaries with low incomes are more likely than beneficiaries with higher incomes to have health problems. They are more likely to be in fair or poor health, have one or more impairments regarding activities of daily living (ADL), and experience certain health problems such as diabetes. Women are significantly more likely than men to have low incomes. Black and Hispanic beneficiaries have higher poverty rates than non-Hispanic whites. Disabled Medicare beneficiaries under age 65-those receiving Social Security payments because of a permanent disability-are another vulnerable group. Compared with Medicare's elderly, these individuals were more likely to report fair or poor health status, functional impairments, and mental health problems. Compounding their health problems is poverty: more than two-fifths (43%) of Medicare's disabled under age 65 live at or below the poverty level. Two of five (41%) receive assistance from Medicaid, and less than a quarter (22%) have Medigap coverage or an employer-sponsored policy to supplement their traditional Medicare coverage. Satisfaction with Medicare Medicare beneficiaries generally gave the program high ratings, with more than half (57%) reporting they are "very satisfied," another quarter (27%) reporting they are "satisfied," and only a fraction (7%) reporting they are "dissatisfied." This high level of satisfaction holds true when analyzed by income level, health status, and type of insurance (traditional Medicare or Medicare HMO). Disabled beneficiaries under age 65 were a notable exception: they were significantly less likely than the elderly to report being "very satisfied" with Medicare. Access Difficulties In general, a relatively low proportion of Medicare's elderly and disabled reported health care access problems. Less than 3 percent of Medicare beneficiaries said they did not get needed care, a finding that underscores the value of Medicare's universal health insurance protection. One of seven beneficiaries (15%), though, did report difficulties obtaining needed care. However, reports of health care access problems differ when broken down by beneficiary income, age, and health status. Beneficiaries with health problems or low incomes are at higher risk for experiencing difficulties gaining access to care: more than one of five beneficiaries (23%) who perceive their health to be fair or poor had difficulties getting needed care, and comparable rates were reported for those with long-term care needs and those living in poverty. The under-65 disabled are at relatively greater risk of having an access problem, with a third (33%) reporting difficulties getting needed care and a quarter (25%) reporting problems obtaining home health services, mental health care, or specialist care. Access problems also vary by type of insurance coverage. Those with Medigap or retiree health supplements to Medicare were less likely than all others to report difficulty getting needed care.
Medicaid Use among Older Low-Income Medicare Enrollees in California and Texas: A Tale of Two States
Journal of Health Politics, Policy and Law, 2019
Context: States face increasing Medicaid expenditures largely as a result of growing dual-eligible populations. In this article we examine self-reported community-based Medicaid participation among Medicare recipients 65 and older in California and Texas, with a particular focus on the older Mexican-origin population. Methods: We use six waves of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) covering the period from 1993–94 to 2010–11. Findings: The data reveal relatively high Medicaid participation rates by older individuals of Mexican origin, but significant differences between the two states. At baseline, 30% of older Mexican-origin Medicare beneficiaries in California reported receiving Medicaid compared to 41% in Texas. Conclusions: Despite California's more liberal eligibility criteria, community-dwelling Texans were more likely than Californians to report coverage at some point during the 17-year follow-up. Our data, as well as ...
State practices in providing health and long-term care to dually eligible persons
was established in 1989 and receives ongoing funding from the Ohio General Assembly through the Ohio Board of Regents. Dr. Mehdizadeh's research expertise is in estimating prevalence of disability among older population, examining health and long-term care utilization patterns of dual eligible persons, and evaluating long-term care use patterns of disabled people. Her work at Scripps Gerontology Center includes a series of projections of the number of disabled older people in Ohio and their needs (with Suzanne Kunkel and Robert Applebaum). She is the co-principal investigator on an eight-year longitudinal study in Ohio that tracks use patterns for home and nursing home care for the Ohio Department of Aging. She recently completed a study of health and long-term care utilization patterns of dually eligible persons in Ohio. Currently she is the principal investigator of a project entitled Dual Eligibles: How Do They Utilize Health and Long-Term Care Services. Her interests are in designing and evaluating coordinated health and long-term care delivery systems for dual eligible persons.
Health Economics, 2009
Individuals with dual enrollment in Medicare and Medicaid have become the focus of heightened US federal and state policy interest in recent years. These beneficiaries are among the most vulnerable and costly persons served by either program. This analysis uses a reduced-form econometric model and a unique survey of community-resident dual enrollees to take a critical step toward understanding the relationships and combinations of state long-term care (LTC) policies and their relative effectiveness in achieving their intended effects: increasing access to care, improving activities of daily living/instrumental activities of daily living (ADL/IADL) assistance, and reducing unmet needs. We then simulate the effects of alternative policies to determine the most effective combination.