Analysis of Dual-Eligible Beneficiaries

The Hilltop Institute conducts analyses of the demographics, service utilization, and expenditures of Maryland’s dual-eligible population. The analyses focus on Medicare beneficiaries in Maryland who also receive full Medicaid benefits. The findings provide an overview of how this population accesses health care services, the types of services used, and where the services are provided.

The chart book, Maryland Dual-Eligible Beneficiaries: CY 2015 to CY 2019, provides an overview of Maryland dual-eligible beneficiaries with breakdowns by benefit category, age, race, gender, and county of residence; the cost to Medicare and Medicaid of providing care to this population; and the prevalence and costs of chronic health conditions.

Integration Requirements for Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) Annual Program Review, CY 2021, is the first annual review of the integration requirements for Medicare Advantage D-SNPs, completed for the Maryland Department of Health. The goal of D-SNP integration is to improve coordination of care transitions for individuals who are dually eligible for Medicare and Medicaid. To meet this goal, D-SNPs are required to notify the state designees (e.g., supports planners) of Medicare hospital and skilled nursing facility (SNF) admissions when members receive long-term services and supports (LTSS) through a home and community-based services (HCBS) waiver or state plan program. This review describes key findings from the first year of implementation, focusing on aggregate trends.

These three reports provide further analyses of Maryland’s dual-eligible beneficiaries:

Maryland Full-Benefit Dual-Eligible Beneficiaries’ Use of Medicare and Medicaid Services Preceding and Following a Medicare Inpatient Stay explores dual eligible beneficiaries’ use of post-acute care (i.e., skilled nursing, inpatient rehabilitation, nursing facility services, hospice, and home health services) in the 30 days immediately following an inpatient stay, as well as their settings of care in the 7 days preceding an inpatient stay. In addition to pre- and post-inpatient settings, the report examines demographics, county of residence, and the most frequent diagnosis-related groups for the population studied.

Characteristics of Maryland Full-Benefit Dual-Eligible Beneficiaries with Three or More Inpatient Stays explores utilization of inpatient services by “high utilizer” full-benefit dual-eligible beneficiaries, defined as those who had three or more inpatient stays during CY 2012. The report examines demographics and county of residence; providers serving this population; chronic conditions and most frequent diagnosis-related groups; and Medicare and Medicaid expenditures and service days.

An Analysis of Selected Mental Health Conditions among Maryland Full-Benefit Dual-Eligible Beneficiaries examines this population’s mental health conditions, including number and type of mental health conditions; demographics and county of residence; emergency department use; and Medicare and Medicaid expenditures and service days.