The upshot of our new @AJMC_Journal paper on risk adjusting for dual-eligibility https://bit.ly/2Xvfoct  : let’s pretend I’m a dual-eligible beneficiary with Medicare Advantage. I live in Tennessee, so I qualify for PARTIAL Medicaid benefits with my 85% FPL annual income. /1

I move to North Carolina because I might as well be social distancing at the ocean if I (understandably) can’t go see my favorite act at the Ryman. I now qualify for FULL Medicaid benefits in North Carolina with 85% FPL income. /2

My income is the same

My health is the same

I’m dual-eligible in both states

BUT now my Medicare Advantage plan is paid more to cover me because my new state offers more generous Medicaid benefits (full instead of partial) to those with income between 76-99% FPL. /3

Let’s pretend you own a Medicare Advantage plan.

Would you prefer to operate in a state where on average Medicare pays you less to cover dual-eligible members with income <100% FPL & those members have fewer Medicaid benefits? /4

Also true for readmission penalties ( https://bit.ly/31nwfyM  by @kejoynt & team)

Let’s pretend you own a hospital.

Would you like to be in a state where Medicare is more likely to penalize you b/c it doesn’t count all your dual-eligible patients with income <100% FPL? /5

If you can concentrate on reading the paper in all its full wonky glory at this point, go for it. Or save it for the next time you adjust a regression or quality measure or capitated payment for dual-eligibility and wonder if the difference between full and partial matters. /6

Many thanks to the terrific coauthors on this paper. Those on Twitter include @MelindaBBuntin, @SalamaFreed, and @lstewart_93. Part of a larger project funded by @commonwealthfnd /7

Finally, if you’ve made it this far in the thread, you may also appreciate this friendly PSA that I like to mention whenever possible: the ACA did not change Medicaid income limits for Medicare beneficiaries. /8