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Eligibility and Enrollment in Medicaid for Low-Income Medicare Beneficiaries: The Role of State Policy

Cornelio, Noelle (2023) Eligibility and Enrollment in Medicaid for Low-Income Medicare Beneficiaries: The Role of State Policy. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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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 and encourages timely utilization of necessary health care services. However, poor coordination between safety net programs, complex Medicaid eligibility and enrollment rules, and state variation in Medicaid rules create substantial differences in who is eligible for and who receives Medicaid. This dissertation focuses on how variation in state Medicaid policy affects Medicaid eligibility and enrollment, cost-related barriers to care, and heath care utilization in low-income aging and disabled populations.

In the first project, I examine changes in Medicaid take-up associated with policy reforms in states that broadened Medicaid eligibility and simplified enrollment for older and disabled individuals with Medicare using a difference-in-differences design. In the second project, I assess opportunities to increase joint enrollment in Medicaid and the Supplemental Nutrition Assistance Program (SNAP) and measure state variation in Medicaid and SNAP enrollment among low-income individuals 65 and older. The final project, I utilize a simulated Medicaid eligibility index to evaluate whether broadening Medicaid eligibility and simplifying enrollment for older adults who were dually eligible for Medicare affected the length of Medicaid enrollment, access to care, or utilization of health care services.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Cornelio, Noellenoc17@pitt.edunoc170000-0002-6954-7237
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairSabik, Lindsay, Mlsabik@pitt.edulsabik
Committee MemberRoberts, Ericeric.roberts@pitt.edueric.roberts
Committee MemberDegenholtz, Howard, Bhoward.degenholtz@pitt.edudegen
Committee MemberBear, Todd, Mtobst2@pitt.edutobst2
Date: 3 January 2023
Date Type: Publication
Defense Date: 11 November 2022
Approval Date: 3 January 2023
Submission Date: 14 December 2022
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 114
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Health Policy & Management
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Medicaid, Medicare, SNAP, eligibility, enrollment, access, utilization, senior, disabled
Date Deposited: 03 Jan 2023 15:14
Last Modified: 03 Jan 2023 15:14


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