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New Evidence of State Variation in Medicaid Payment Policies for Dual Medicare-Medicaid Enrollees: Policy Database and Index

posted on 19.08.2020, 15:35 by Eric RobertsEric Roberts
These data track state Medicaid programs' policies for paying Medicare's cost sharing for low-income individuals who have Medicare and Medicaid ("dual eligibles"). Our database focuses on Medicaid policies for paying the cost sharing for outpatient and physician services covered by the Medicare Part B program. We track state policies longitudinally from 2004-2018 based on information abstracted from online Medicaid policy documents, legal databases, and policy data reported to us by 22 state Medicaid programs. We also developed a Medicaid payment index, which reflects the proportion of the Medicare Part B allowed amount (i.e., price) for physician office visits that providers would expect to be paid per service provided to a dual eligible patient, in aggregate from Medicare and Medicaid, given these state policies. One version of this index reflects payments to physicians who qualified for higher Medicaid fees under the Affordable Care Act's Medicaid Fee Bump (implemented nationally from 2013-14) and one version reflects payments to physicians who were ineligible for the fee bump.

Download the attached Excel files to retrieve the database and additional documentation. The compressed folder 'final document library' contains the original source policy documents (in PDF format) that are catalogued in the database.

More detail about this database and our findings can be found in the article:

Roberts ET, Nimgaonkar A, Aarons J, Tomko H, Shartzer A, Zuckerman SB, and James AE. "New Evidence of State Variation in Medicaid Payment Policies for Low-Income Medicare Beneficiaries," Health Services Research 2020 (doi: 10.1111/1475-6773.13545).


Financial assistance for low-income Medicare beneficiaries: Using natural experiments to assess effects on care and health outcomes

Agency for Healthcare Research and Quality

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Commonwealth Fund (grant number 20191988)

University of Pittsburgh Pepper Older Americans Independence Center (subaward from National Institute on Aging grant P30 AG024827-13)