The Effects of Care Coordination on Service Utilization for Individuals Dually Enrolled in Medicare and Medicaid: Evidence From the Washington Health Home Managed Fee-For-Service Demonstration

Abstract

Individuals dually enrolled in Medicare and Medicaid often experience fragmented care that fails to meet their health care needs and is unduly expensive due to a lack of coordination between Medicare and Medicaid programs. Washington state’s Health Home Managed Fee-For-Service demonstration, part of the Financial Alignment Initiative, sought to improve care and reduce costs for high-cost, high-risk dual enrollees through care coordination. Using Medicare and Medicaid administrative claims data from 2016 to 2019, we evaluate the impact of the Washington demonstration on health care utilization using a modified regression discontinuity design. We find that for relatively healthy enrollees on the margin of eligibility for the demonstration, enrollment in the demonstration modestly reduced emergency department visits, ambulatory care visits, and some types of home and community-based service (HCBS) use and reduced nursing facility stays for older enrollees, but did not impact inpatient or skilled nursing facility admissions. Addressing the fragmentation of coverage, care, and financing for dual enrollees remains an important policy and research priority.