State payment limitations on Medicare cost-sharing: impact on dually eligible beneficiaries

The Balanced Budget Act (BBA) of 1997 allowed states to limit how much their Medicaid programs contributed toward the Medicare cost-sharing liability of dually eligible beneficiaries. Policymakers have grown concerned that such limitations may affect access to care for these beneficiaries. We used a quasi-experimental design to analyze changes in access from 1996 to 1998, using Medicare and Medicaid data from nine states. Cost-sharing payments fell in six of the nine states following the BBA, and access to outpatient physician visits for dually eligible beneficiaries was reduced relative to non-dually eligible beneficiaries in those states.