{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T14:46:51Z","timestamp":1782312411291,"version":"3.54.5"},"reference-count":23,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["5R01MD017068"],"award-info":[{"award-number":["5R01MD017068"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the association between state increases in income or asset eligibility limits for Medicare Savings Programs (MSP), which provide assistance with Medicare cost\u2010sharing and\/or premiums, and MSP enrollment and health care use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>We used interrupted time series analysis to evaluate changes in MSP enrollment rates before and after expansion. We estimated associations between post\u2010expansion enrollment in MSPs with outpatient visits, prescription drug fills, emergency department (ED) visits, and hospitalizations using a matched difference\u2010in\u2010differences approach. Matching variables included individual and area\u2010level sociodemographic characteristics, comorbidity scores, and MSP eligibility group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>We used Medicare data from four states that met the inclusion criteria of having at least 24\u2009months of data before and after their expansion between 2006 and 2019: Connecticut (income and assets), Indiana (income), New York (assets), and Oregon (assets).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>Relative to predicted enrollment in the absence of MSP expansion, actual enrollment over 24\u2009months increased by varying degrees: 65.3% in Connecticut and 34.1% in Indiana, but only 3.9% and 3.7% in New York and Oregon, respectively. In Connecticut and Indiana, the two states that raised income limits, post\u2010expansion enrollment in MSPs was associated with increased prescription drug use overall (e.g., 380 fills per 1000 beneficiaries per month in Connecticut, 95% CI: 333, 427) and in three chronic drug classes, and decreased hospitalizations (e.g., \u22124 hospitalizations per 1000 beneficiaries per month in Indiana, 95% CI: \u22127, \u22122).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MSP eligibility expansions had positive but variable impacts on enrollment across states, with larger increases in states that expanded eligibility by raising income limits versus those that only eliminated asset tests. In the states that raised income limits, post\u2010expansion enrollment in MSPs was associated with increased use of chronic drugs, underscoring the potential clinical value of financial assistance for low\u2010income beneficiaries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70116","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T10:07:15Z","timestamp":1777284435000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["State Expansions in Medicaid Financial Assistance for Low\u2010Income Medicare Beneficiaries: Changes in Enrollment and Use"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8078-5431","authenticated-orcid":false,"given":"Vicki","family":"Fung","sequence":"first","affiliation":[{"name":"Mongan Institute Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Cheng","sequence":"additional","affiliation":[{"name":"Biostatistics Massachusetts General Hospital and Harvard Medical School  Somerville and Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Price","sequence":"additional","affiliation":[{"name":"Mongan Institute Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2862-8550","authenticated-orcid":false,"given":"Kobi","family":"Khong","sequence":"additional","affiliation":[{"name":"Mongan Institute Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyou","family":"Yang","sequence":"additional","affiliation":[{"name":"Mongan Institute Massachusetts General Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felippe O.","family":"Marcondes","sequence":"additional","affiliation":[{"name":"Mongan Institute Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1534-7919","authenticated-orcid":false,"given":"J. Wyatt","family":"Koma","sequence":"additional","affiliation":[{"name":"Interfaculty Initiative in Health Policy Harvard University and Massachusetts General Hospital  Cambridge and Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Hsu","sequence":"additional","affiliation":[{"name":"Mongan Institute Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2241-707X","authenticated-orcid":false,"given":"Margarita","family":"Alegria","sequence":"additional","affiliation":[{"name":"Mongan Institute Massachusetts General Hospital and Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph P.","family":"Newhouse","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy Harvard Medical School, Harvard T.H. Chan School of Public Health, Harvard Kennedy School, and National Bureau of Economic Research  Boston and Cambridge Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hec.4902"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.12062"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2020.02272"},{"key":"e_1_2_9_5_1","volume-title":"Chapter\u00a03: Medicare Savings Programs: Enrollment Trends","author":"Medicaid and CHIP Payment and Access Commission","year":"2024"},{"key":"e_1_2_9_6_1","volume-title":"Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid","author":"Medicare Payment Advisory Commission, Medicaid and CHIP Payment and Access Commission","year":"2024"},{"key":"e_1_2_9_7_1","volume-title":"Promising Strategies for Medicare Savings Program Enrollment: Modifying Eligibility Criteria and Documentation Requirements | Rutgers","author":"Tiedemann A. 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