Those enrolling in Medicaid as they neared death incurred markedly lower median PPPM expenditures than those enrolled for longer periods of time.
Predictors of PPPM expenditures are presented in Table 4.
Our findings showed positive association between hospice and PPPM expenditures.
That dually-eligible Black beneficiaries incur significantly lower PPPM expenditures than others is somewhat unexpected given findings from a previous study showing that minorities incur higher expenditures than White beneficiaries (Degenholtz, Thomas, and Miller, 2003).
Already the dominant group (relative to adults with disabilities) in terms of number of beneficiaries, total public expenditures, average PPPM public expenditures, and use of institutional LTC, dually eligible elderly beneficiaries will place severe pressure on both the Medicare and Medicaid programs as the number of elderly people continues to grow.
The average PPPM expenditures for Medicare and Medicaid combined were $2,053 for dually eligible elderly beneficiaries, nearly six times the average PPPM for elderly beneficiaries with Medicare only ($363).
Medicaid spent an additional $304 PPPM on all other services, with prescription drugs ($85) and community LTC ($80) being the second and third largest of these.
This large group is often referred to as "well" because of their relatively low spending, but with average expenditures of $987 PPPM (Figure 5), the group clearly includes subgroups with significant expenditures for acute or chronic care.
5 times the PPPM of the community-dwelling persons not enrolled in an EHCBSW program (Figure 5).
In 1995 spending on this group averaged $2,682 PPPM (Figure 5).
As previously shown in Figure 5, combined Medicare and Medicaid costs for EHCBSW participants averaged $2,682 PPPM, compared with $3,531 for those living in institutional LTC settings.
For those in nursing facilities, Medicaid paid 84 percent (82,954) of the PPPM costs and Medicare paid 16 percent (8579).