# Access to Care by Low Income Senior Medicare Beneficiaries: Direct and Indirect Effects of Medicaid Policy on Enrollment, Healthcare Utilization, Spending and Health

> **NIH AHRQ R01** · TUFTS UNIVERSITY MEDFORD · 2020 · $209,905

## Abstract

Project Summary/Abstract
For many low-income persons aged 65 and older, both Medicare and Medicaid can have significant impacts on
access to healthcare, healthcare spending, and overall health. Medicare serves as the primary payer of their
healthcare, while Medicaid is intended to cover cost-sharing and services that Medicare does not. However,
three important connections between these two programs are poorly understood. First, although past estimates
suggest that participation rates are very low, up-to-date estimates of Medicaid program participation among
adults aged 65 and older are unavailable. Second, the factors associated with Medicaid participation by
seniors are also understudied. Third, the extent to which recent changes in the Medicaid program have
spillover effects on low-income seniors' healthcare use, spending, and health is unknown. The broad objective
of this proposal is to better understand linkages between Medicare and Medicaid in the form of dual program
enrollment and indirect spillover effects of Medicaid program expansions on community-dwelling low-income
seniors who are enrolled in Medicare and eligible for full Medicaid benefits, hereafter referred to as low-income
seniors. This project has three specific aims: 1) to conduct a comprehensive analysis of full Medicaid program
participation by low-income seniors to identify differences in Medicaid program participation over time and
across subgroups and precipitating factors associated with program participation; 2) to investigate the extent to
which recent policy changes under the Affordable Care Act lead low-income seniors to enroll in the program;
and 3) to leverage recent policy changes to identify the net spillover effects of Medicaid expansions to the non-
elderly on health and healthcare use among low-income seniors. This project will first compile a detailed
dataset of full Medicaid eligibility criteria for all U.S. states and for each year from 2006-2020. Those eligibility
criteria will be used to identify low-income seniors eligible for full Medicaid in several existing large publicly
available and restricted use national household and individual surveys. These surveys complement each other
in terms of their scope, focus, and sample population. This project will produce estimates of the rates of full
Medicaid participation by low-income seniors over time and for various subgroups, and will identify life events
that immediately precede full Medicaid enrollment. Finally, this project will use quasi-experimental methods
and multivariate regression analysis to estimate the unintended spillover effects of policies that expand
Medicaid coverage to non-elderly adults on Medicaid participation, healthcare utilization, spending, and health
status among low-income seniors. This project will provide important evidence that will inform strategies to
address the health needs of the high-cost, vulnerable population of low-income seniors. The project will also
inform policies to i...

## Key facts

- **NIH application ID:** 9935070
- **Project number:** 5R01HS025422-04
- **Recipient organization:** TUFTS UNIVERSITY MEDFORD
- **Principal Investigator:** Melissa Powell McInerney
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $209,905
- **Award type:** 5
- **Project period:** 2017-08-01 → 2022-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9935070

## Citation

> US National Institutes of Health, RePORTER application 9935070, Access to Care by Low Income Senior Medicare Beneficiaries: Direct and Indirect Effects of Medicaid Policy on Enrollment, Healthcare Utilization, Spending and Health (5R01HS025422-04). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/9935070. Licensed CC0.

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