# Impact of Medicaid Policies on Low-Income Medicare Beneficiaries: Evidence From State Reforms

> **NIH AHRQ R36** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2021 · $43,200

## Abstract

PROJECT SUMMARY/ABSTRACT
Approximately 12 million low-income Medicare beneficiaries are dually enrolled in Medicaid, which pays for
services not covered by Medicare and defrays out-of-pocket costs, which can be substantial for relatively poor
people. Medicare’s premiums, deductibles, and coinsurance average over 40% of an individual’s Social
Security income, which represents the sole source or majority of income for many low-income Medicare
beneficiaries. Medicaid coverage enables low-income Medicare beneficiaries to afford care they might
otherwise forego due to cost. However, poor coordination between Medicare and Medicaid, complex Medicaid
eligibility and enrollment rules, and state variation in Medicaid rules create substantial differences in who is
eligible for and receives Medicaid. This proposal focuses on how variation in state Medicaid policy affects
Medicaid enrollment, cost-related barriers to care, and heath care utilization in low-income aging and disabled
populations.
The proposed study will use recent Medicaid policy changes in Indiana and Ohio as a natural experiment to
assess how increasing eligibility and simplifying enrollment impacted the low-income Medicare population.
Data from the American Community Survey, Behavioral Risk Factor Surveillance System, and Medicare claims
will be used to address the specific aims of this research. Aim 1 will estimate changes in Medicaid enrollment
following eligibility expansions for low-income Medicare beneficiaries. Enrollment in Medicaid lowers out-of-
pocket cost sharing requirements and facilitates care seeking. Therefore, Aim 2 will examine how access to
care was affected by changes in Medicaid eligibility for low-income Medicare beneficiaries. Increases in health
care utilization are expected for services where Medicare’s cost-sharing requirements are reduced or
eliminated by Medicaid, and for services that may be sensitive to deferred preventive care use. Aim 3 will
analyze changes in healthcare utilization after Medicaid eligibility expanded for low-income Medicare
beneficiaries. Difference-in-differences and event study models will be utilized.
The proposed project’s aims align with the Agency for Healthcare Research and Quality’s (AHRQ) mission “to
produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable,” and a
Healthy People 2020 goal to improve access to care. Additionally, three AHRQ Priority Populations, the
elderly, low-income, and those with special healthcare needs are the focus of the proposal. Findings from this
proposal can inform future policy, research, and programs to promote access to care in low-income, aging, and
disabled populations.

## Key facts

- **NIH application ID:** 10227305
- **Project number:** 1R36HS027698-01A1
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Noelle Cornelio
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $43,200
- **Award type:** 1
- **Project period:** 2021-09-01 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10227305

## Citation

> US National Institutes of Health, RePORTER application 10227305, Impact of Medicaid Policies on Low-Income Medicare Beneficiaries: Evidence From State Reforms (1R36HS027698-01A1). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/10227305. Licensed CC0.

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