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Some States with high Medicaid use of home care may be able to shift some of these visits to Medicare

Some States with high use of home care visits by Medicaid patients may have an opportunity to shift the costs of some of these visits to Medicare, according to a study supported by the Agency for Healthcare Research and Quality (HS11262 and National Research Service Award training grant T32 HS00032). Use of Medicare for home care nearly doubled between 1990 and 1996. Use of Medicaid for home care services also jumped dramatically during this period.

Instead of waiting for Medicare to pay or deny claims for home care services, as most States do, some States paid claims up front with Medicaid funds and then submitted the claims to Medicare for certain dual eligibles (patients eligible for both Medicaid and Medicare). Getting Medicare to pay for these visits has not reduced Medicaid fiscal liability to a significant extent. However, higher Medicaid home care spending was associated with a lower probability and amount of Medicare use, indicating that States may look for ways to decrease Medicaid home care use by shifting some of the burden to Medicare.

This approach might be particularly helpful when a State's overall Medicaid budget is high, and there is pressure to reduce outlays, explains Wayne L. Anderson, of the Research Triangle Institute, University of North Carolina. The researchers linked individual microlevel data from the Medicare Current Beneficiary Survey from 1992 to 1997 to State-level data on billing practices to identify the effects of those practices on Medicare home care use.

See "Medicare maximization by State Medicaid programs: Effects on Medicare home care utilization," by Wayne L. Anderson, Edward C. Norton, and William H. Dow, in the June 2003 Medical Care Research and Review 60(2), pp. 201-222.

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