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A comparative analysis of Medicaid long-term care policies and their effects on elderly dual enrollees


  • J. Bradford Rice

    (Department of Economics, Boston University, Boston, MA, USA)

  • Judith D. Kasper

    (Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA)

  • Liliana E. Pezzin

    (Department of Medicine and Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI, USA)


Individuals with dual enrollment in Medicare and Medicaid have become the focus of heightened US federal and state policy interest in recent years. These beneficiaries are among the most vulnerable and costly persons served by either program. This analysis uses a reduced-form econometric model and a unique survey of community-resident dual enrollees to take a critical step toward understanding the relationships and combinations of state long-term care (LTC) policies and their relative effectiveness in achieving their intended effects: increasing access to care, improving activities of daily living|instrumental activities of daily living (ADL|IADL) assistance, and reducing unmet needs. We then simulate the effects of alternative policies to determine the most effective combination. The combination of policies that was most effective in reducing the percentage of individuals receiving low levels of assistance was high spending in the community relative to nursing home and low community LTC spending per recipient; that is, spending more on community care and spreading it across more people. Overall, this analysis confirms that Medicaid LTC policy decisions by states, and the combinations of policies that are implemented, result in important variations in levels of assistance to elderly persons with disabilities. Copyright © 2008 John Wiley & Sons, Ltd.

Suggested Citation

  • J. Bradford Rice & Judith D. Kasper & Liliana E. Pezzin, 2009. "A comparative analysis of Medicaid long-term care policies and their effects on elderly dual enrollees," Health Economics, John Wiley & Sons, Ltd., vol. 18(3), pages 275-290.
  • Handle: RePEc:wly:hlthec:v:18:y:2009:i:3:p:275-290
    DOI: 10.1002/hec.1367

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    References listed on IDEAS

    1. Susan L. Ettner, 1997. "Medicaid participation among the eligible elderly," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 16(2), pages 237-255.
    2. Douglas Staiger & James H. Stock, 1997. "Instrumental Variables Regression with Weak Instruments," Econometrica, Econometric Society, vol. 65(3), pages 557-586, May.
    3. Bisakha Sen, 2003. "A preliminary investigation of the effects of restrictions on Medicaid funding for abortions on female STD rates," Health Economics, John Wiley & Sons, Ltd., vol. 12(6), pages 453-464.
    4. Gertler, Paul J, 1992. "Medicaid and the Cost of Improving Access to Nursing Home Care," The Review of Economics and Statistics, MIT Press, vol. 74(2), pages 338-345, May.
    5. Anna Aizer, 2003. "Low Take-Up in Medicaid: Does Outreach Matter and for Whom?," American Economic Review, American Economic Association, vol. 93(2), pages 238-241, May.
    6. Jonathan Gruber, 1997. "Policy Watch: Medicaid and Uninsured Women and Children," Journal of Economic Perspectives, American Economic Association, vol. 11(4), pages 199-208, Fall.
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    Cited by:

    1. Thomas Barnay & Sandrine Juin, 2014. "Does care to dependent elderly people living at home increase their mental health?," TEPP Working Paper 2014-06, TEPP.
    2. Momtaz, Yadollah Abolfathi & Hamid, Tengku Aizan & Ibrahim, Rahimah, 2012. "Unmet needs among disabled elderly Malaysians," Social Science & Medicine, Elsevier, vol. 75(5), pages 859-863.
    3. repec:kap:ijhcfe:v:17:y:2017:i:2:d:10.1007_s10754-016-9200-x is not listed on IDEAS
    4. repec:eee:jhecon:v:58:y:2018:i:c:p:43-66 is not listed on IDEAS
    5. Barnay, Thomas & Juin, Sandrine, 2016. "Does home care for dependent elderly people improve their mental health?," Journal of Health Economics, Elsevier, vol. 45(C), pages 149-160.
    6. Zantomio, Francesca, 2013. "Older people's participation in extra-cost disability benefits," Journal of Health Economics, Elsevier, vol. 32(1), pages 320-330.
    7. Judite Goncalves & France Weaver, 2014. "Home care, hospitalizations, and doctor visits," Research Papers by the Institute of Economics and Econometrics, Geneva School of Economics and Management, University of Geneva 14095, Institut d'Economie et Econométrie, Université de Genève.

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