Tipirneni Renuka, Furst Wendy, Ruggiero Dominic A, Singer Dianne C, Solway Erica, Beathard Erin, Patel Syama R, Stefanescu Andrei R, Kullgren Jeffrey T, Ayanian John Z, Roberts Eric T
Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor.
Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor.
JAMA Health Forum. 2025 Jan 3;6(1):e244692. doi: 10.1001/jamahealthforum.2024.4692.
Dual-eligible older adults rely on Medicaid to pay for Medicare premiums and cost sharing in addition to supplemental services including dental and long-term care. However, the unique experiences of dual-eligible older adults with Medicaid unwinding remain unknown.
To assess the awareness and experiences of dual-eligible older adults with Medicaid redetermination.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional national survey of community-dwelling US adults aged 65 years or older with incomes less than or equal to 100% of the federal poverty level, via internet and telephone, was conducted from January 23 through February 19, 2024. Participants were recruited from NORC probability-based and 2 additional national nonprobability panels.
Weighted percentage values for respondent awareness of Medicaid redeterminations, experiences navigating reenrollment, and cost-related barriers to accessing care.
Of 843 respondents, most were female (62.9%), aged 65 to 74 years (62.3%), and had completed up to high school education (72.3%). Overall, 16.1% (95% CI, 12.4%-19.9%) had heard a lot and 34.6% (95% CI, 28.9%-40.4%) a little about states returning to Medicaid renewals; 49.0% (95% CI, 43.0%-55.0%) heard nothing at all. A total of 45.1% completed a Medicaid renewal, 37.0% did not complete a renewal, and 17.7% did not know about renewal requirements. A total of 87.7% maintained Medicaid, 5.9% lost Medicaid but got it back, and 5.5% lost Medicaid and did not get it back. In the last 6 months, 7.7% reported delaying or forgoing care due to cost. Delayed or forgone care was more common among those who lost Medicaid and did not get it back (18.4%) and those who lost Medicaid but got it back (30.6%) compared with those who maintained Medicaid (5.5%). Cost-related barriers were more common for dental (25.1%) and home health services (18.5%), which are frequently covered by Medicaid.
The findings highlight a need to address informational gaps and navigational barriers related to Medicaid unwinding among older adults with dual eligibility for Medicare and Medicaid. Addressing these gaps may help to avoid Medicaid losses that contribute to difficulties accessing care.
符合双重资格的老年人依靠医疗补助计划来支付医疗保险保费和费用分摊，此外还包括牙科和长期护理等补充服务。然而，符合双重资格的老年人在医疗补助计划逐步取消过程中的独特经历仍不为人知。
评估符合双重资格的老年人对医疗补助计划重新认定的知晓情况和经历。
设计、背景和参与者：2024年1月23日至2月19日，通过互联网和电话对美国65岁及以上、收入低于或等于联邦贫困线100%的社区居住成年人进行了一项全国性横断面调查。参与者从基于概率的全国民意研究中心（NORC）以及另外两个全国性非概率样本中招募。
受访者对医疗补助计划重新认定的知晓情况、重新注册的经历以及获得护理的费用相关障碍的加权百分比值。
在843名受访者中，大多数为女性（62.9%），年龄在65至74岁之间（62.3%），最高学历为高中（72.3%）。总体而言，16.1%（95%置信区间，12.4%-19.9%）听说过很多关于各州恢复医疗补助计划续保的事情，34.6%（95%置信区间，28.9%-40.4%）听说过一点，49.0%（95%置信区间，43.0%-55.0%）根本没听说过。共有45.1%的人完成了医疗补助计划续保，37.0%的人未完成续保，17.7%的人不知道续保要求。共有87.7%的人保留了医疗补助计划，5.9%的人失去了医疗补助计划但又重新获得，5.5%的人失去了医疗补助计划且未重新获得。在过去6个月中，7.7%的人报告因费用问题推迟或放弃了护理。与保留医疗补助计划的人（5.5%）相比，失去医疗补助计划且未重新获得的人（18.4%）以及失去医疗补助计划但又重新获得的人（30.6%）中，推迟或放弃护理的情况更为常见。与医疗补助计划经常覆盖的牙科（25.1%）和家庭健康服务（18.5%）相关的费用障碍更为常见。
研究结果凸显了有必要解决与医疗保险和医疗补助计划双重资格的老年人在医疗补助计划逐步取消过程中相关的信息差距和导航障碍。解决这些差距可能有助于避免导致获得护理困难的医疗补助计划损失。
