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US Veterans’ Enrollment in Medicaid: Implications for the Expanded Medicaid Eligibility Under the ACA

Hynes DM, de Groot K, Joyce MM, Weichle TW, Kok LS, Kan D. US Veterans’ Enrollment in Medicaid: Implications for the Expanded Medicaid Eligibility Under the ACA. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA.

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Research Objective: To describe and examine US veterans' enrollment in Medicaid and establish a baseline for predictors of enrollment prior to the implementation of the Affordable Care Act. Study Design: In a retrospective study design, we focused initially on those veterans enrolled in the US Department of Veterans Affairs Health Administration (VHA) as of 2008. We linked VHA enrollment files to the Medicaid Person Summary files. We examined demographics, including gender, age, race, and state of residence; VHA priority level; reasons for Medicaid eligibility; and concurrent Medicare enrollment and as predictors of Medicaid enrollment. Population Studied: Initial analysis included all Veterans enrolled in VHA during September 2008. Detailed analysis included only Veterans who were dually enrolled in VHA and Medicaid during the month. Principal Findings: In September 2008, there were 7.4 million Veterans enrolled in VHA. Of these, 5.3% were also enrolled in Medicaid. Seventy-two (72%) of the VHA-Medicaid dually enrolled Veterans were also enrolled in Medicare. The states with the highest percent of Veterans enrolled in Medicaid were Maine (14.6%), District of Columbia (10.6%), Vermont (10.6%), and Massachusetts (10.3%). The states with the lowest percent of Veterans enrolled in Medicaid were Montana (3.0%), Virginia (3.0%), and Utah (3.1%). Approximately 50% of VHA-Medicaid dual enrollees were eligible for Medicaid due to old age; 36% were eligible to due disability; 14% were eligible for other reasons. Almost all (99%) Veterans who were eligible for Medicaid due to old age and 60.3% of Veterans eligible for Medicaid due to disability were also enrolled in Medicare. Patterns of Medicaid enrollment varied greatly by age and gender. Female enrollment in Medicaid peaked in the youngest age group (18-24; 11.2%) and declined with age to only 5.3% for women ages 45-64, then increased again after age 65 to 10.4%. In contrast, males had very low levels of Medicaid enrollment (less than 3%) until after age 45. Between ages 45 and 64, 5.0% of Veterans were VHA-Medicaid dually enrolled and it increased slightly after age 65 to 6.2%. Conclusion: Approximately 5% of Veterans enrolled in the Veterans' Health Administration (VHA) are also enrolled in Medicaid. Women, the disabled, and the elderly were more likely to be enrolled in Medicaid. This research also provides a framework for considering factors that may affect Medicaid enrollment for the larger veteran population and deserves attention as the ACA is rolled out. Implications: Prior research has found that over a million non-elderly veterans and their families lacked health insurance coverage. While VHA coverage is available to many veterans, priority and access are based on service-connected disabilities, income level, and other factors. As our research shows, even veterans enrolled in VHA may also seek Medicaid enrollment. Those dually enrolled in VHA and Medicaid often have situations or conditions that require specialized care. The impact of the expanded Medicaid eligibility under the Affordable Care Act on veterans' choice of health insurance coverage deserves further attention.

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