The effect of Medicaid coverage on use of health services by low-income elderly people

Abstract

Tat-sang Lum, MSW, is a doctoral candidate, George Warren Brown School of Social Work, Washington University, One Brookings Drive, St. Louis, MO 63130-4899; e-mail: yslum@artsci. wustl .edu. Hong-jer Chang , PhD, is assistant professor, Fu-Jen Catholic University, Hsin Chuang City, Taipei, Taiwan. Since Act, as have lions Titles they the improved of disadvantaged XVIII Medicare were and enacted access XIX and to people. by of Medicaid health the Congress Social Medicare care programs Security in for 1965 promilas Titles XVIII and XIX of the Social Security Act, the Medicare and Medicaid programs have improved access to health care for millions of is dvantaged p opl . M dic re pro vides almost universal health insurance coverage for elderly people aged 65 or older and disabled workers who meet the eligibility requirements. Medicaid, on the other hand, provides health insurance coverage for millions of low-income people. Some people may be eligible for both Medicare and Medicaid. In 1994, among the 35 million Medicaid recipients, 4 million were low-income elderly people and a majority of them were dual eligibles they were covered by both Medicare and Medicaid (Health Care Financing Administration, 1996). Low-income elderly people may be eligible for Medicaid if they belong to one of the following four categories: those who receive cash benefits from the federal Supplemental Security Income program (SSI), those who have excessive medical or longterm care expenses relative to income, those who have income below the federal poverty threshold and limited financial assets (qualified Medicare beneficiaries), and those who have income between 100 and 120 percent of the federal poverty threshold and limited financial assets (specified lowincome Medicare beneficiaries). In 1994 Medicaid covered about 20 percent of elderly people with incomes below 150 percent of the federal poverty threshold (Health Care Financing Administration, 1996). Compared with recipients in other age groups, lowincome elderly people had the highest per-user Medicaid payments. Although only 11.5 percent of the Medicaid recipients were low-income elderly people, they accounted for 31 percent (33.6 billion) of the total payments (Health Care Financing Administration, 1996). The interdependence of Medicaid and Medicare, the disproportionate share of Medicaid expenditures by lowincome elderly people, and the rapidly increasing elderly population have made