Identifying Dual-Eligible Beneficiaries With Long-Term Services and Supports Use in Medicare Enrollment Data

Identifying dual-eligible beneficiaries who use Medicaid-funded long-term services and supports (LTSS) is difficult, hindering efforts to monitor use and improve quality. We demonstrate a strategy that uses only Medicare data to identify nursing home (NH) users and Medicaid home-and-community-based-service (HCBS) waiver participants by leveraging the fact that these groups exclusively qualify for zero cost-sharing in Part D. In a multistate cohort of low-income older adults, we identified Part D LTSS beneficiaries (dual-eligible beneficiaries with zero Part D cost-sharing) in Medicare enrollment records and verified LTSS use in NH assessments and Medicaid HCBS data. Over 96% of NH/HCBS waiver users in MDS or Medicaid data were correctly identified as Part D LTSS beneficiaries, and 93% of beneficiaries without NH or HCBS waiver use were accurately identified as not being Part D LTSS beneficiaries. Leveraging Part D data could support more timely evidence on quality and outcomes for dual-eligible LTSS users.