Write a critical summary of the paper, and make a suggestion for 1 or 2 other variables or factors that the author could have used in the paper
Include a “Lessons Learned” paragraph.
Return to work: A critical aspect of care coordination for younger
Jae Kennedy, Ph.D.a,*, Gilbert Gimm, Ph.D.b, and Elizabeth Blodgett, M.H.P.A.c
aDepartment of Health Policy and Administration, Washington State University, Spokane, WA 99210-1495, USA
bDepartment of Health Administration and Policy, George Mason University, Fairfax, VA 22030-4444, USA
cDepartment of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599-7411, USA
Background: Annual health care costs for dual eligibles now top $300 billion. Many dual eligibles are under age 65 and their needs
differ significantly from retired elderly dual eligibles. For younger dual eligibles, successful return to work is an important objective for
Objectives: To assess relative rates of dual eligibility by age group and program enrollment (SSDI or OASI), and to identify the prevalence
among these subgroups of factors associated with return to work.
Methods: Population estimates and logistic regression analysis of the 2010 Medicare Current Beneficiary Survey (MCBS).
Results: Although they make up only 16% of the total Medicare beneficiary population, disabled workers under age 65 constitute 42%
of all dual eligibles. SSDI beneficiaries under age 45 have 20 times greater odds of receiving Medicaid benefits compared to retirees
(AOR 5 19.8, 95% CI 5 16.2e24.2). The youngest dual eligible adults are more likely to work, have fewer chronic conditions, and report
better health status than other dual eligibles. However, they are more likely to report problems with obtaining health care and be dissatisfied
with the quality of the care they receive.
Conclusions: Dual eligible workers with disabilities are an important target population for coordinated services because of their high
lifetime program costs e many will receive SSDI, SSI, Medicare, and Medicaid benefits for decades. Return to work and continued employment
are important policy objectives for younger dual eligibles and should provide the greatest return in terms of reduced dependence on
federal disability programs. 2013 Elsevier Inc. All rights reserved.
Keywords: Medicaid; Medicare; SSDI; Disabled workers; Return to work; Coordinated care
The Medicare and Medicaid programs combined spend
over $300 billion annually for the 9.2 million adults who
are enrolled in both programs. Slowing the growth of these
costs is a priority for the Federal Coordinated Health Care
Office (FCHCO) and the Center for Medicare and Medicaid
Innovation (CMMI). At present, most cost-containment
efforts are focused on avoiding hospitalizations and nursing
home admissions among older dual eligibles. However,
42% of dual eligible beneficiaries are ‘‘working age’’
(i.e., under age 65) and therefore eligible for Medicare as
Social Security Disability Insurance (SSDI) beneficiaries.
This group has received relatively little research or policy
attention.1 In this paper, we show how the needs of lowincome
disabled workers can be quite different from those
of retired elderly dual eligibles.
Dual eligibles receive Medicaid coverage when they
meet state categorical and income eligibility criteria.
Although Medicaid is considered to be a ‘‘second payer’’
when there is an overlap in service coverage with Medicare,
many essential disability support services, like personal
assistance, are only covered through Medicaid. Most young
dual eligibles also receive Supplemental Security Income in
addition to SSDI benefit payments. Because they are
enrolled in at least three public programs, younger dual
eligibles represent a significant cost to the Social Security
Administration (SSA) and to states.2
Average annual Medicare and Medicaid costs incurred by
younger dual eligibles ($19,000) are slightly lower than
those incurred by older dual eligibles ($19,700), but younger
dual eligibles account for decades more of enrollment,
resulting in higher lifetime costs. Their financial assistance
Funding for this study was provided by the National Institute on
Disability and Rehabilitation Research (Grant H133G070055, Jae Kennedy,
PI) and the WA Life Sciences Discovery Fund (Grant LSDF
08-02, John Roll, PI). These agencies had no further role in study design,
in the collection, analysis and interpretation of data, or in the writing of the
* Corresponding author. Tel.: þ1 509 368 6971; fax: þ1 509 358 7984.
E-mail address: [email protected] (J. Kennedy).
1936-6574/$ – see front matter 2013 Elsevier Inc. All rights reserved.
Disability and Health Journal 6 (2013) 95e99