Individuals that are enrolled in both Medicare and Medicaid — otherwise known as dual beneficiaries — utilize home health care at higher rates than those who are only beneficiaries of Medicare.
That’s according to a recent report from ATI Advisory, with support from Arnold Ventures. The report is a profile of the growing population of individuals in the U.S. who receive both Medicare and Medicaid coverage.
Of the 63.1 million individuals who are Medicare beneficiaries, almost 12 million are dually eligible for both Medicare and Medicaid.
Overall, dual beneficiaries use home health services at twice the rate of Medicare-only beneficiaries.
“Efforts to integrate between Medicaid and Medicare have been shown to reduce Medicare utilization,” ATI wrote in the report. “As a result, states continue to be interested in opportunities to share in Medicare savings with CMS in part to account for state costs associated with implementing and maintaining an integrated program.”
Due to navigating two uncoordinated systems, dual beneficiaries typically experience worse health outcomes and hurdles when it comes to care access. This results in higher spending across both Medicaid and Medicare, according to the report.
In fact, Medicare and Medicaid spent $440 billion on dual beneficiaries in 2019.
“Annual income is strongly associated with unmet social needs and increased morbidity and mortality,” the organization wrote. “Income-related health disparities appear to be growing over time. Non-primarily health-related supplemental benefits offered by Medicare Advantage plans can play an important role in addressing the social needs and improving the overall health of dually eligible beneficiaries.”
Aside from socio-economic status, the report also examined the types of communities dual beneficiaries reside in. While four in five Medicare beneficiaries – including dual and Medicare-only – reside in urban areas, one in five live in suburban or rural areas.
“Beneficiaries in suburban and rural areas may experience more challenges in accessing specialized health care services when needed and may have less access to public transportation and job opportunities,” ATI wrote. “Such challenges may be particularly impactful for dual beneficiaries due to their lower incomes.”
Seniors living in rural areas face increased barriers when trying to access home- and community-based care, especially compared to their urban counterparts.
Factors such as workforce retention, limited access to the internet and limited availability of long-term supports and services providers all play a role in the home-based care access disparities in rural communities.
Another key finding in the report was that dual beneficiaries typically enroll in Medicare Advantage plans more than Medicare-only beneficiaries. This hasn’t always been the case.
“Historically, dual beneficiaries were less likely to enroll in Medicare Advantage than Medicare-only beneficiaries, but, in recent years, this trend has changed as a result of broadened Medicare Advantage supplemental benefits,” the organization wrote.
The report suggests that Medicare Advantage is positioned to support the “unique needs” of dual beneficiaries because it serves more than half of these individuals.
“Policies that redesign Medicare Advantage should consider the impact on dual beneficiaries as the program increasingly plays an important role in their outcomes,” ATI wrote.
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