Delays in access to an Alzheimer’s treatment for individuals dually eligible for Medicare and Medicaid in the U.S.

Abstract

AbstractBackgroundPrior research has predicted substantial wait times for access to a disease‐modifying Alzheimer’s treatment because of the combination of a highly prevalent disease and a complex diagnostic process. Access could be particularly limited for individuals dually eligible for Medicare and Medicaid in the U.S. in some states. Medicaid programs cover Medicare cost‐sharing requirements for their indigent members, but under the so‐called “lesser of” policy, states may elect to pay only up to the Medicaid rate which is typically less than the Medicare rate. In states with that policy, providers will only receive the lower Medicaid rate, which is known to reduce appointment availability. We estimate the effect of the policy on wait times.MethodWe use a Markov model to predict wait times for dually eligible and regular Medicare beneficiaries. Counts of both groups by age, sex and states came from Census data and Medicare enrollment records, specifics of each state’s Medicaid policy from published data and inquiries to states, and prevalence and incidence data as well as price elasticity of supply from published data.ResultAt total of 35 states and the District of Columbia have a “lesser of” policy and pay less than the Medicare rate for elective specialty care. The average wait time for dually eligibles is between 5.9 and 48.5 months with an average of 17.5 compared to between 3.6 and 42.5 with an average of 13.8 for regular Medicare beneficiaries in those states. Conversely, wait times are indistinguishable in states without that policy, as Figure 1 illustrates. As Figure 2 shows, the difference means that duals have a 30.3% higher average wait times than regular Medicare beneficiaries with a range of 61.2% in DC and 1.2% in Georgia.ConclusionThe “lesser of” policy is likely to reduce access for the socio‐economically disadvantaged group of dually eligibles, who also suffer from a higher disease burden. The delays would translate into avoidable disease progression and mortality, raising concerns about health equity.