MCBS

MCBS Order Description Write a critical summary of the paper, and make a suggestion for 1 or 2 other variables or factors that the author could have used in the paper Include a "Lessons Learned" paragraph. Research Paper Return to work: A critical aspect of care coordination for younger dual eligibles Jae Kennedy, Ph.D.a,*, Gilbert Gimm, Ph.D.b, and Elizabeth Blodgett, M.H.P.A.c aDepartment of Health Policy and Administration, Washington State University, Spokane, WA 99210-1495, USA bDepartment of Health Administration and Policy, George Mason University, Fairfax, VA 22030-4444, USA cDepartment of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599-7411, USA Abstract Background: Annual health care costs for dual eligibles now top $300 billion. Many dual eligibles are under age 65 and their needs differ significantly from retired elderly dual eligibles. For younger dual eligibles, successful return to work is an important objective for coordinated care. Objectives: To assess relative rates of dual eligibility by age group and program enrollment (SSDI or OASI), and to identify the prevalence among these subgroups of factors associated with return to work. Methods: Population estimates and logistic regression analysis of the 2010 Medicare Current Beneficiary Survey (MCBS). Results: Although they make up only 16% of the total Medicare beneficiary population, disabled workers under age 65 constitute 42% of all dual eligibles. SSDI beneficiaries under age 45 have 20 times greater odds of receiving Medicaid benefits compared to retirees (AOR 5 19.8, 95% CI 5 16.2e24.2). The youngest dual eligible adults are more likely to work, have fewer chronic conditions, and report better health status than other dual eligibles. However, they are more likely to report problems with obtaining health care and be dissatisfied with the quality of the care they receive. Conclusions: Dual eligible workers with disabilities are an important target population for coordinated services because of their high lifetime program costs e many will receive SSDI, SSI, Medicare, and Medicaid benefits for decades. Return to work and continued employment are important policy objectives for younger dual eligibles and should provide the greatest return in terms of reduced dependence on federal disability programs. 2013 Elsevier Inc. All rights reserved. Keywords: Medicaid; Medicare; SSDI; Disabled workers; Return to work; Coordinated care The Medicare and Medicaid programs combined spend over $300 billion annually for the 9.2 million adults who are enrolled in both programs. Slowing the growth of these costs is a priority for the Federal Coordinated Health Care Office (FCHCO) and the Center for Medicare and Medicaid Innovation (CMMI). At present, most cost-containment efforts are focused on avoiding hospitalizations and nursing home admissions among older dual eligibles. However, 42% of dual eligible beneficiaries are ‘‘working age’’ (i.e., under age 65) and therefore eligible for Medicare as Social Security Disability Insurance (SSDI) beneficiaries. This group has received relatively little research or policy attention.1 In this paper, we show how the needs of lowincome disabled workers can be quite different from those of retired elderly dual eligibles. Dual eligibles receive Medicaid coverage when they meet state categorical and income eligibility criteria. Although Medicaid is considered to be a ‘‘second payer’’ when there is an overlap in service coverage with Medicare, many essential disability support services, like personal assistance, are only covered through Medicaid. Most young dual eligibles also receive Supplemental Security Income in addition to SSDI benefit payments. Because they are enrolled in at least three public programs, younger dual eligibles represent a significant cost to the Social Security Administration (SSA) and to states.2 Average annual Medicare and Medicaid costs incurred by younger dual eligibles ($19,000) are slightly lower than those incurred by older dual eligibles ($19,700), but younger dual eligibles account for decades more of enrollment, resulting in higher lifetime costs. Their financial assistance Funding for this study was provided by the National Institute on Disability and Rehabilitation Research (Grant H133G070055, Jae Kennedy, PI) and the WA Life Sciences Discovery Fund (Grant LSDF 08-02, John Roll, PI). These agencies had no further role in study design, in the collection, analysis and interpretation of data, or in the writing of the report. * Corresponding author. Tel.: þ1 509 368 6971; fax: þ1 509 358 7984. E-mail address: [email protected] (J. Kennedy). 1936-6574/$ - see front matter 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.dhjo.2013.01.003 Disability and Health Journal 6 (2013) 95e99 www.disabilityandhealthjnl.com