@article {8674,
	title = {Physical and/or Cognitive Impairment, Out-of-Pocket Spending, and Medicaid Entry among Older Adults.},
	journal = {J Urban Health},
	volume = {93},
	year = {2016},
	month = {2016 10},
	pages = {840-850},
	abstract = {<p>While Medicare provides health insurance coverage for those over 65~years of age, many still are underinsured, experiencing substantial out-of-pocket costs for covered and non-covered services as a proportion of their income. Using the Health and Retirement Study (HRS), this study found that being underinsured is a significant predictor of entering into Medicaid coverage over a 16-year period. The rate of entering Medicaid was almost twice as high for those who were underinsured and with physical and/or cognitive impairment than those who were not, while supplemental health insurance reduced the rate of entering Medicaid by 30~\%. Providing more comprehensive coverage through the traditional Medicare program, including a ceiling on out-of-pocket expenditures or targeted support for those with physical or cognitive impairment, could postpone becoming covered by Medicaid and yield savings in Medicaid.</p>},
	keywords = {Aged, Cognitive Dysfunction, Delivery of Health Care, Disabled Persons, Eligibility Determination, Female, Financing, Personal, Humans, Insurance Coverage, Insurance, Health, Male, Medicaid, Middle Aged, United States},
	issn = {1468-2869},
	doi = {10.1007/s11524-016-0078-1},
	url = {https://link.springer.com/article/10.1007\%2Fs11524-016-0078-1},
	author = {Willink, Amber and Davis, Karen and Schoen, Cathy and Jennifer L. Wolff}
}
@article {9215,
	title = {Risks for nursing home placement and Medicaid entry among older Medicare beneficiaries with physical or cognitive impairment.},
	journal = {Issue Brief (Commonwealth Fund)},
	volume = {37},
	year = {2016},
	month = {2016 Oct},
	pages = {1-14},
	abstract = {Issue: More than half of individuals who age into Medicare will experience physical and/or cognitive impairment (PCI) at some point that hinders independent living and requires long-term services and supports. As a result of Medicare{\textquoteright}s limits on covered services, Medicare beneficiaries with PCI experience financial burdens and reduced ability to live independently. Goal: Describe the characteristics and health spending of Medicare beneficiaries with PCI and estimate the likelihood of Medicaid entry and long-term nursing home placement. Methods: The Health and Retirement Study 1998{\textendash}2012 is used to estimate long-term nursing home placement, as well as Medicaid entry. The Medicare Current Beneficiary Survey 2012 provides information on health care spending and utilization. Key findings and conclusions: Almost two-thirds of community-dwelling Medicare beneficiaries with PCI have three or more chronic conditions. More than one-third of those with PCI have incomes less than 200 percent of the federal poverty level but are not covered by Medicaid; almost half spend 10 percent or more of their incomes out-of-pocket on health care. Nineteen percent of individuals with PCI and high out-of-pocket costs entered Medicaid over 14 years, compared to 10 percent without PCI and low out-of-pocket costs.},
	keywords = {Cognitive Ability, Disabilities, Medicare/Medicaid/Health Insurance, Nursing homes},
	issn = {1558-6847},
	author = {Willink, Amber and Davis, Karen and Schoen, Cathy}
}
