Table 2. Access to Care Overall and Differences by Type of Medicare Plan Among Dually Eligible Users of HCBSa.
| Outcome | Beneficiaries, mean (SD), % | D-SNPs with EAE vs traditional Medicare | D-SNPs without EAE vs traditional Medicare | D-SNPs with EAE vs without EAE | All D-SNPs vs traditional Medicare | ||||
|---|---|---|---|---|---|---|---|---|---|
| Difference, PPs (95% CI)b | P valuec | Difference, PPs (95% CI)b | P valuec | Difference, PPs (95% CI)b | P valuec | Difference, PPs (95% CI)b | P valuec | ||
| Difficulty d | |||||||||
| Primary care | 10.9 (31.1) | −2.55 (−6.34 to 1.23) | .19 | −1.16 (−4.73 to 2.40) | .52 | −1.39 (−4.87 to 2.09) | .78 | −1.88 (−5.06 to 1.29) | .25 |
| Specialist care | 13.8 (34.5) | −0.15 (−4.49 to 4.19) | .95 | −1.90 (−5.71 to 1.90) | .33 | 1.75 (−2.24 to 5.74) | .39 | −1.14 (−4.61 to 2.33) | .52 |
| Mental health services | 5.6 (23.1) | −0.49 (−3.34 to 2.37) | .74 | −0.17 (−2.82 to 2.48) | .90 | −0.31 (−2.96 to 2.33) | .82 | −0.63 (−2.98 to 1.72) | .60 |
| Prescription medications | 12.5 (33.1) | −2.37 (−6.61 to 1.88) | .27 | −3.31 (−7.12 to 0.51) | .09 | 0.94 (−2.79 to 4.67) | .62 | −3.06 (−6.55 to 0.44) | .09 |
| Medical equipment and/or supplies | 18.5 (38.9) | −3.37 (−8.20 to 1.46) | .17 | −3.17 (−7.66 to 1.32) | .17 | −0.20 (−4.51 to 4.11) | .93 | −3.72 (−7.78 to 0.35) | .07 |
| Dental care | 20.5 (40.4) | −1.45 (−6.35 to 3.46) | .56 | −1.12 (−5.59 to 3.36) | .62 | −0.33 (−4.94 to 4.27) | .88 | −1.58 (−5.60 to 2.43) | .44 |
| Vision care | 12.7 33.3) | −1.02 (−5.20 to 3.17) | .63 | −1.03 (−4.79 to 2.73) | .59 | 0.01 (−3.84 to 3.87) | .99 | −1.27 (−4.66 to 2.12) | .46 |
| Hearing care | 9.3 (29.1) | −0.76 (−4.29 to 2.78) | .68 | −2.48 (−5.56 to 0.59) | .11 | 1.73 (−1.64 to 5.09) | .31 | −2.04 (−4.83 to 0.74) | .15 |
| HCBSe | 16.9 (37.4) | −0.30 (−4.89 to 4.29) | .90 | 2.31 (−1.98 to 6.61) | .29 | −2.61 (−7.01 to 1.78) | .24 | 1.29 (−2.54 to 5.13) | .51 |
| Any care | 46.2 (49.9) | −5.30 (−11.26 to 0.67) | .08 | −1.19 (−6.75 to 4.37) | .67 | −4.11 (−9.63 to 1.42) | .15 | −2.81 (−7.81 to 2.19) | .27 |
| Delays in receiving plan approvals f | |||||||||
| Medications | 31.4 (46.4) | −1.60 (−7.37 to 4.16) | .59 | 0.79 (−4.59 to 6.17) | .77 | −2.40 (−7.64 to 2.86) | .37 | −0.20 (−5.07 to 4.66) | .93 |
| Specialists | 27.3 (44.5) | 1.70 (−3.82 to 7.21) | .55 | 5.01 (−0.13 to 10.15) | .06 | −3.32 (−8.50 to 1.87) | .21 | 3.53 (−1.09 to 8.15) | .13 |
| HCBS | 32.2 (46.7) | 0.61 (−5.21 to 6.43) | .84 | 2.31 (−3.22 to 7.83) | .41 | −1.70 (−7.02 to 3.63) | .53 | 1.59 (−3.38 to 6.56) | .53 |
Abbreviations: D-SNPs, Dual Eligible Special Needs Plans; EAE, exclusively aligned enrollment; HCBS, home and community-based services; PPs, percentage points.
eAppendix 5 in Supplement 1 gives more information on the outcome variable construction, and eAppendix 6 in Supplement 1 gives the full model results.
Estimates were adjusted for the covariates in Table 1 and were weighted using propensity score weights.
Significance levels based on robust SEs.
Defined as having a lot of difficulty or some difficulty vs no difficulty or no need.
Defined in the survey as “care and other in-home services and conveniences that help with daily activities (personal care services, adult day care, skilled nursing, etc).”
Text of questions refers to delays in getting plan approvals from the respondent’s Medicaid health plan.