Effect of long-term care use on Medicare and Medicaid expenditures for dual eligible and non-dual eligible elderly beneficiaries

BACKGROUND: Dual eligible Medicare and Medicaid beneficiaries consume disproportionate shares of both programs.

OBJECTIVES: To compare Medicare and Medicaid expenditures of elderly dual eligible beneficiaries with non-dual eligible beneficiaries based on their long-term care (LTC) use.

RESEARCH DESIGN: Secondary analysis of linked MAX and Medicare data in seven states.

SUBJECTS: Dual eligible adults (65+) receiving LTC in institutions, in the community, or not at all; and Medicare non-dual eligibles.

MEASURES: Medicaid acute medical and LTC expenditures per beneficiary year, Medicare expenditures.

RESULTS: Among dual eligibles and non-dual eligibles, the average number of diseases and case mix scores are higher for LTC users. Adjusting for case mix virtually eliminates the difference for medical costs, but not for LTC expenditures. Adjusting for LTC status reduces the difference in LTC costs, but increases the difference in medical costs.

CONCLUSIONS: Efforts to control costs for dual eligibles should target those in LTC while better coordinating medical and LTC expenditures.