State Payment Limitations on Medicare Cost-Sharing: Impacts on Dually Eligible Beneficiaries and Their Providers
Section 125 of the Benefits Improvement and Protection Act (BIPA) of 2000, directed the Secretary of Health and Human Services to conduct a “Study on Limitation on State Payment for Medicare Cost-Sharing Affecting Access to Services for Qualified Medicare Beneficiaries”. That section requires that the study “determine whether access to certain services (including mental health services) for qualified Medicare beneficiaries has been affected by limitations on a State’s payment for Medicare cost-sharing for such beneficiaries…” In addition, the study is to “analyze the effect of such payment limitation on providers who serve a disproportionate share of such beneficiaries”. To our knowledge, this is the first study to determine how much state Medicaid programs actually pay, and how such payments affect both dually eligible beneficiaries and the providers that serve them. Our study is based on a quasi-experimental design that analyzes changes in access from 1996 (pre-Balanced Budget Act [BBA]) to 1998 (post-BBA). We take advantage of cross-state differences in both levels of cost-sharing payments and the magnitude of the payment change. In addition, we use the experience of non-dual Medicare beneficiaries to control for changes over time in service use that are not related to changes in costsharing payments. Nine states were included in the study. They were classified into three groups based on how their state plans reported they paid for Medicare Part B deductibles and coinsurance.