From Locked Out to Opting in: How the Cures Act Reshaped Medicare Advantage Utilization for Beneficiaries With End‐Stage Kidney Disease

OBJECTIVE: To describe how the characteristics of Medicare Advantage (MA) beneficiaries with end-stage kidney disease (ESKD) changed after the 21st Century Cures Act expanded MA eligibility, and to document accompanying changes in utilization. STUDY SETTING AND DESIGN: The 2021 Cures Act opened MA to previously diagnosed ESKD patients. Prior to 2021, ESKD patients were ineligible for MA unless diagnosed while enrolled. This cross-sectional descriptive study used 2017-2023 claims to compare enrollee characteristics before and after 2021, using interrupted time-series analysis of monthly hospitalizations, emergency department visits, and outpatient visits. DATA SOURCES AND ANALYTIC SAMPLE: Optum's de-identified Clinformatics Data Mart Database (2017-2023) provided data on 216,205 MA beneficiaries with ESKD (359,172 beneficiary-years). PRINCIPAL FINDINGS: Post-policy, enrollees were younger, had lower comorbidity burden and lower education attainment, and were more likely to report household incomes below $40,000. Hospitalization rates were lower immediately post-policy by 0.013 per beneficiary-month (6% relative decline; 95% CI, -0.022 to -0.003; p < 0.05). ED visits showed no immediate difference but increased over time. Outpatient visits remained largely stable. CONCLUSIONS: Expanded MA eligibility was associated with a substantial shift in the ESKD MA case mix toward younger, relatively healthier, and more socioeconomically vulnerable beneficiaries. Utilization changes reflect these compositional differences.