Study: Dual-eligible beneficiaries dropped from Medicaid still got Part D subsidies

Dollar bill with a hole in Washington's face on it and the word "Medicaid" in its place
Dual-eligible beneficiaries dropped from Medicaid still got Medicare Part D subsidies, even though eligibility criteria for both are the same. (zimmytws/GettyImages)

A new study found dual-eligible beneficiaries dropped from Medicaid still got Medicare Part D subsidies even though the eligibility criteria is the same.

The study published Monday in the journal Health Affairs looked at the rates of disenrollment from Medicaid for dual-eligible beneficiaries from 2012 to 2016. The results come as the federal government is searching for ways to better coordinate the care for dual-eligible beneficiaries between Medicare and Medicaid services because of the high cost of spending on such beneficiaries.

The study found that 18.2% of Medicare beneficiaries who get full or partial Medicaid were dropped from the program for reasons other than death during that five-year period. More than 50% of those Medicare beneficiaries who went without Medicaid for one year still got low-income subsidies for Medicare Part D prescription drug coverage.

“Virtually all Medicare beneficiaries who receive these subsidies are eligible for Medicaid as a result of these programs’ closely aligned eligibility criteria,” the study said.

The study authors were also concerned that the Medicaid disenrollment rates were “very similar” to rates reported 16 years ago. The rates highlight major gaps in Medicaid coverage among those on Medicare, the study said.

RELATED: CMS offers states chance to test new integrated care models for dual eligibles 

Currently there are more than 11 million people enrolled in both Medicare and Medicaid.

Dual-eligible beneficiaries can be costly for the federal government, historically accounting for 34% of Medicare spending and 33% of Medicaid spending, according to a 2012 report from the Centers for Medicare & Medicaid Services.

CMS is trying to rein in spending on dual-eligible beneficiaries by better coordinating care between payment systems for Medicare and Medicaid.

Back in April, the agency offered new models that states can adopt to treat such beneficiaries.

One option includes allowing Medicaid programs to use private payers to cover services for dual eligible at a capitated rate. The agency is also encouraging states to create integrated models for treating dual eligible beneficiaries.

Study authors also found that state policies mitigated the amount of Medicaid disenrollment.

RELATED: Avalere—High needs of dual eligibles in MA highlight importance of alternative benefits

One state policy endorsed in the study would automatically enroll beneficiaries in the federal Supplemental Security Income program, which provides financial assistance to aging and disabled low-income people, into full Medicaid.

There were 34 states and the District of Columbia that had this policy in 2016, according to the study.

“By reducing the administrative burden of eligibility renewals, automatic enrollment of [Supplemental Security Income] recipients may reduce Medicaid disenrollment,” the study said.