Panel: Payment and Care Policies and Spending on High-Cost Medicaid Beneficiaries
(Health Policy)

Friday, November 9, 2018: 10:15 AM-11:45 AM
McKinley - Mezz Level (Marriott Wardman Park)

*Names in bold indicate Presenter

Panel Chairs:  Sandra Decker, Agency for Healthcare Research and Quality
Discussants:  Michel Boudreaux, University of Maryland and Laura Dague, Texas A&M University

Reduced Physician Payments Associated with Less Use of Physician Office Care and More Use of Emergency Rooms By Dual-Eligibles
Xiaotong Niu1, Sandra Decker2 and Tamara Hayford1, (1)Congressional Budget Office, (2)Agency for Healthcare Research and Quality

Estimating Eligibility for Medicaid Homeless Support Service Benefits and Potential Healthcare Savings in New Jersey
Joel C. Cantor1, Sujoy Chakravarty1, Jose Nova1, Taiisa Kelly2, Derek DeLia3 and Richard Brown2, (1)Rutgers Center for State Health Policy, (2)Monarch Housing Associates, (3)Medstar Health Research Institute

A substantial fraction of Medicaid spending is devoted to the care of people with high needs, such as dual-eligibles and those who use long-term care services and supports. Medicaid also covers nearly 40 percent of children and 15 percent of nonelderly adults. Therefore, it is important to evaluate the effects of payment policies on both access to care and the quality of that care. This session demonstrates the extent to which payment policies and more direct interventions in care delivery (such as care coordination) can affect those measures.


The first two papers examine how Medicaid payment policies affected access to care. The first of those examines the effect of Medicaid payment policies related to the coverage of Medicare cost sharing for dual-eligibles enrolled in the Qualified Medicare Beneficiary program. Each state can decide whether Medicaid covers all, some, or none of dual-eligible beneficiaries’ Medicare cost-sharing requirements, which has a large impact on physician reimbursement rates. That paper found that dual-eligible beneficiaries in states that lowered total payments to physicians had greater emergency room use and reduced access to primacy care.  


More recently, the Affordable Care Act mandated states’ Medicaid payment rates to match the Medicare rates for primary care visits in 2013 and 2014. The second paper finds that a greater increase in payment rates led to a greater improvement in the access to primary care and a shift from emergency care and hospital outpatient services to office-based care. The effects are greater for Medicaid-only beneficiaries.


Beyond incentivizing providers for more effective care through the payment system, better care coordination can improve care at lower costs. In the third paper, care coordination is shown to reduce overall Medicaid spending among dual-eligible beneficiaries with dementia who live at home by reducing hospitalizations and nursing facility admissions.


Following the three presentations, discussants will highlight common themes from the presentations followed by time for questions from the audience.

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