Key result
Medicare beneficiaries in low-socioeconomic areas who were readmitted 60-66 days after discharge and charged a new deductible were 21% more likely to enroll in Medicaid compared to those readmitted 53-59 days after discharge.
Why the study?
Does increased Medicare inpatient cost-sharing increase Medicaid enrollment among low-income beneficiaries?
Observational (n=221,248)
Does increased Medicare inpatient cost-sharing increase Medicaid enrollment among low-income beneficiaries?
Relative Risk: 1.21 (95% CI 1.03–1.4)
Absolute Event Rate: 3.7% vs 3.1%
p-value: p=0.01
Increasing Medicare cost-sharing requirements for inpatient readmissions promotes Medicaid enrollment among low-income beneficiaries, potentially offsetting intended Medicare savings.
Readmission timing was associated with Medicaid enrollment in low-income patients; leaves open causal effects of Medicare cost-sharing policies.
OBJECTIVE: To isolate the effect of greater inpatient cost-sharing on Medicaid entry among Medicare beneficiaries. DATA SOURCES: Medicare administrative data (years 2007-2010) were linked to nursing home assessments and area-level socioeconomic indicators. STUDY DESIGN: Medicare beneficiaries who are readmitted to a hospital must pay an additional deductible ($1,100 in 2010) if their readmission occurs more than 59 days following discharge. In a regression discontinuity analysis, we take advantage of this Medicare benefit feature to test whether beneficiaries with greater cost-sharing have higher rates of Medicaid enrollment. DATA EXTRACTION METHODS: We identified 221,248 Medicare beneficiaries with an initial hospital stay and a readmission 53-59 days later (no deductible) or 60-66 days later (charged a deductible). PRINCIPAL FINDINGS: Among beneficiaries in low-socioeconomic areas with two hospitalizations, those readmitted 60-66 days after discharge were 21 percent more likely to join Medicaid compared with those readmitted 53-59 days following their initial hospitalization (absolute difference in adjusted risk of Medicaid entry: 3.7 percent vs. 3.1 percent, p = .01). CONCLUSIONS: Increasing Medicare cost-sharing requirements may promote Medicaid enrollment among low-income beneficiaries. Potential savings from an increased cost-sharing in the Medicare program may be offset by increased Medicaid participation.
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Keohane et al. (2017) conducted an observational in Medicare beneficiaries with hospital readmissions (n=221,248). Hospital readmission 60-66 days after discharge (subject to new deductible) vs. Hospital readmission 53-59 days after discharge (no new deductible) was evaluated on Medicaid entry within 3 months of second hospital admission among beneficiaries in low-socioeconomic areas (RR 1.21, 95% CI 1.03-1.40, p=0.01). Medicare beneficiaries in low-socioeconomic areas who were readmitted 60-66 days after discharge and charged a new deductible were 21% more likely to enroll in Medicaid compared to those readmitted 53-59 days after discharge.
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