Health Care Spending Differs Among Patients With Dual Medicare-Medicaid Eligibility

Among Medicare beneficiaries with full Medicaid benefits, health care needs and service use varied among subgroups, according to study findings published online in JAMA Health Forum.

“Substantial use of both Medicare- and Medicaid-funded services was found across all need-based subgroups, and the services contributing a high proportion of the total spending differed across subgroups,” wrote a research team from Duke University, Durham, North Carolina.

The study included 333,240 Medicare and Medicaid beneficiaries in North Carolina. Researchers were interested in describing health care use and spending among 4 needs-based subgroups: community well (the subgroup included beneficiaries who did not meet criteria for other subgroups but could also include patients with barriers to care), home- and community-based services users, nursing home residents, and intensive behavioral health users.

Overall, combined Medicare and Medicaid spending per person-year (PPY) was $26,874, according to the study, with an even split in funding between Medicare and Medicaid. Outpatient facility care ($7138) and professional/carrier claims ($6214) contributed the most to spending.

Among patient subgroups, the community well group had the lowest combined spending at $19,734 PPY. Of that amount, Medicaid paid the lowest portion: $7605, or 38.5%, researchers reported. Nursing home residents had the highest overall spending at $68,359 PPY. For this group, Medicaid contributed the highest portion: 70.1%.

Users of home- and community-based services had combined spending of $40,069 PPY, of which Medicaid accounted for 47.7%, the study found. The largest contributors to spending were professional/carrier claims ($14,523) and outpatient claims ($9012).

“The diversity of health care use among dual-eligible beneficiaries requires integration strategies with comprehensive combined Medicare-Medicaid benefits to support whole-person, beneficiary-centered care for dual-eligible beneficiaries and their families,” researchers advised.

Reference:
Kaufman BG, Jones KA, Greiner MA, et al. Health care use and spending among need-based subgroups of Medicare beneficiaries with full Medicaid benefits. JAMA Health Forum. 2023;4(5):e230973. doi:10.1001/jamahealthforum.2023.0973