Transitions from Medicare-Only to Medicare-Medicaid Enrollment

Transitions from Medicare-Only to Medicare-Medicaid Enrollment

Published: Jan 31, 2014
Publisher: 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
Associated Project

Employment Policy and Measurement Rehabilitation Research and Training Center

Time frame: 2010-2015

Prepared for:

U.S. Department of Education, Office of Special Education and Rehabilitative Services

U.S. Department of Education, National Institute on Disability and Rehabilitation Research


Carol V. Irvin

Key Findings
  • The transition from Medicare-only to the MME status is rare during the calendar year; only 2 percent of Medicare-only beneficiaries transitioned to MME status in 2009.
  • Transition rates were higher for beneficiaries younger than 65 and rates varied considerably across states.
  • About two-thirds of new MME enrollees were eligible for full Medicaid benefits, including LTC services, whereas one-third were only eligible for Medicare cost-sharing benefits.
  • Transition rates were particularly high among Medicare beneficiaries who used LTC services but accounted for only a minority of new MME enrollees. 

The objectives of this study were to provide up-to-date national statistics on transitions from Medicare-only to MME, learn more about the extent to which transitions are associated with LTC use, and examine variations in MME entry across states. We used the 2009 Medicare Master Beneficiary Summary File (MBSF) to identify all fee-for-service MME enrollees age 22 or older. For comparison purposes, we also used the Medicare 5 percent sample to develop a group of Medicare-only beneficiaries who did not transition to MME status during 2009. We linked MBSF data to data from the Chronic Conditions Data Warehouse timeline file for 2009 and the Medicaid Analytic eXtract 2009. We used these data sources to identify the percentage of all Medicare-only beneficiaries in January who were enrolled as MME in December. We assessed how transition rates differed for two key subpopulations of Medicare-only beneficiaries: those living in nursing homes and those living in the community at the beginning of the year. Within these groups, we assessed differences in transition rates based on state and age and disability status.

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