Integrating Medicare and Medicaid for Dual Eligibles with Disabilities: Evaluating the Impact on Utilization, Quality, Mortality, and Chronic Diseases Management

Over 50% of the 12.8 million low-income individuals who are dually eligible for Medicare and Medicaid (“dual eligibles”) qualify for Medicare because of disability. This varied population experiences physical, intellectual, developmental, cognitive, or mental disabilities that substantially limit major life activities. People with disabilities die 10-20 years earlier than those without disability, and much of this premature mortality is preventable. Dual eligibles with disabilities have high prevalence of multiple chronic medical (e.g., diabetes) and behavioral health (e.g., depression) conditions and high need for long-term services and supports (LTSS) for daily activities. Medicare and Medicaid have been poorly integrated to serve dual eligibles, leading to conflicting financial incentives, fragmented care delivery, and complicated administrative processes. Together, these issues drive high healthcare spending and poor health outcomes, including 40-60% avoidable premature mortality, among dual eligibles with disabilities. Integrated SNPs) or for with dual eligible special needs lans (integrated D- are a type of Medicare Advantage (MA) plan that contracts with state Medicaid agencies to cover some all Medicaid services coordinate Medicare and Medicaid benefits and streamline administrative processes dual eligibles. These plans aim to better align financial incentives toward “whole person” care consistent clinical guidelines and to provide comprehensive care management for chronic conditions. p , , Integrated D- SNP enrollment among dual eligibles with disabilities grew 12-fold between 2018 and 2024. Despite rapid growth, there is little evidence on the impact and implementation of integrated D-SNPs overall and none for dual eligibles with disabilities. This study aims to fill this gap using novel linked data capturing the entirety of Medicare and Medicaid services for 100% of dual eligibles with disabilities from 2018-2027. We will use a concurrent-embedded mixed-methods design integrating a quantitative trial emulation approach with difference-in-differences (Aim 1) and survival (Aim 2) analyses with qualitative study of integrated D-SNP implementation (Aim 3). Aims 1-2 will assess how integrated D-SNP enrollment influences care utilization, quality indicators, and chronic diseases management (Aim 1) and mortality (Aim 2) among dual eligibles with disabilities. Aim 3 will characterize integrated D-SNP implementation for dual eligibles with disabilities with the goal of identifying promising practices and areas for improvement. This project is well aligned with the NIH Strategic Plan for Disability Health Research FY26-FY30 and NIA's priority of promoting adherence to medical and behavioral regimens for healthy and adaptive aging in later life. Project Number: 1R01AG099343-01 | Fiscal Year: 2026 | NIH Institute/Center: National Institute on Aging (NIA) | Principal Investigator: Yongkang Zhang (+1 co-PI) | Institution: WEILL MEDICAL COLL OF CORNELL UNIV, NEW YORK, NY | Award Amount: $720,523 | Activity Code: R01 | Study Section: Special Emphasis Panel[ZRG1 HSS-Z (02)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11320195