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Title: Becoming Dual: Measuring the Impact of Gaining Medicaid Coverage for Medicare Beneficiaries

Citation Type: Miscellaneous

Publication Year: 2023

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Abstract: I study the effect of having dual public health insurance coverage on healthcare utilization among US patients. Specifically, I focus on Medicare beneficiaries who gain additional Medicaid coverage, which eliminates out-of-pocket costs for healthcare services. While the lower cost may increase patients' demand for healthcare, I identify a countervailing force: providers are less willing to treat Medicaid patients due to lower reimbursement rates and higher administrative burdens. Using administrative Medi-care claims data and variation from a substantial expansion in dual-Medicaid eligibility in the state of Connecticut, I find that dual enrollment increases patients' total health care utilization by 51 percent, and that much of this increase is driven by a higher use of the emergency department (83 percent increase at the sample mean). At the same time, dual enrollment leads to a 24 percent decline in the number of outpatient physician visits, especially for preventive care. I demonstrate that the decline in outpatient care is concentrated among providers with a low share of Medicaid patients. My findings thus demonstrate the unintended consequences of policies that increase enrollment in dual-Medicaid among patients without changing provider side constraints regarding their willingness to treat Medicaid patients. More broadly, my results speak to the role of the interaction between Medicare and Medicaid-the two primary public health insurance programs in the US-in driving access to care and healthcare spending.

Url: https://web.stanford.edu/~ginali/ginali_JMP.pdf

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Authors: Li, Jing

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Data Collections: IPUMS USA

Topics: Health, Population Health and Health Systems

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