How low-income older adults and people with disabilities manage their health care and navigate complicated policy and insurance plans can be challenging. Federal Medicare programs cover medical needs for millions of older Americans while state Medicaid programs cover long-term services and supports for these populations.
This complicates the provision of care and how those services are administered for those eligible for both programs. Associate Professor Laura Keohane, PhD has spearheaded evaluations of TennCare’s innovative approach to addressing this issue.
Tennessee’s Medicaid program TennCare provides Medicaid benefits through private managed care plans and began requiring in 2015 that all insurers who provide Medicaid benefits must also offer a separate Medicare managed care plan that specializes in meeting the needs of individuals who receive both Medicare and Medicaid—known as “dual-eligible beneficiaries.” If the same insurer provides both Medicare and Medicaid benefits, there may be enhanced opportunities for care coordination and more efficient management of health care services.
A growing number of TennCare members have opted to enroll in aligned Medicare and Medicaid managed care plans operated by same insurer, an arrangement that may make it easier to coordinate benefits. Dr. Keohane’s research demonstrated that increased aligned plan participation was associated with fewer inpatient admissions and prescription drugs for older adults, but increased inpatient admissions among beneficiaries under age 65.
Dr. Keohane also led an evaluation of a new TennCare pay-for-performance system designed to increase ventilator liberation rates among nursing home residents. The number of chronic ventilator users in Tennessee nursing homes decreased after the program began. This work provides important evidence to federal and state policymakers who are considering implementing similar strategies to improve quality of care for dual-eligible beneficiaries.
With the support of federal National Institute on Aging funding, Dr. Keohane is now examining how Medicaid home and community-based services and Medicare Part D insulin coverage can support aging in place for older low-income adults with diabetes and dementia living in the Southeast.
She is a leading contributor to Health Affairs’ Forefront series on Medicare and Medicaid integration, a forum for discussing the latest developments in a way that is accessible to federal and state stakeholders.