Effects of Integrating Care for Medicare-Medicaid Dually Eligible Seniors in Minnesota

ABSTRACT

Individuals dually eligible for Medicare and Medicaid often receive fragmented and inefficient care. Using Minnesota fee-for-service claims, managed care encounters, and enrollment data for 2010–2012, we estimated the likely impact of Minnesota Senior Health Option (MSHO)—seen as the first statewide fully integrated Medicare-Medicaid model—on health care and long-term services and supports use, relative to Minnesota Senior Care Plus (MSC+), a Medicaid-only managed care plan with Medicare fee for service. Estimates suggest that MSHO enrollees had significantly higher use of primary care and, potentially, of community-based services, combined with lower use of hospital-based care than similar MSC+ enrollees. Adopting fully integrated care models like MSHO may have merit in other states.

KEYWORDS:

• Dually eligible
• managed care
• Minnesota
• seniors
• elderly

Acknowledgments

We wish to acknowledge helpful comments on an earlier draft from Pamela Doty and John Drabek, U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

¹ For information on the initiative see the Financial Alignment Initiative webpage: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/FinancialModelstoSupportStatesEffortsinCareCoordination.html.

² For a study of early implementation of MSHO, see Kane, Weiner, Homyak, & Bershadsky, 2001.

³ Individuals who qualified for Medicaid as medically needy were excluded from this study because they were exempt from mandatory MSC+ enrollment.

Additional information

Funding

This work was supported by the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation [HHSP23320100021WI #HHSP23337009T].