{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T07:42:11Z","timestamp":1792482131817,"version":"4.5.0"},"reference-count":19,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To describe how the characteristics of Medicare Advantage (MA) beneficiaries with end\u2010stage kidney disease (ESKD) changed after the 21st Century Cures Act expanded MA eligibility, and to document accompanying changes in utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Setting and Design<\/jats:title>\n                    <jats:p>The 2021 Cures Act opened MA to previously diagnosed ESKD patients. Prior to 2021, ESKD patients were ineligible for MA unless diagnosed while enrolled. This cross\u2010sectional descriptive study used 2017\u20132023 claims to compare enrollee characteristics before and after 2021, using interrupted time\u2010series analysis of monthly hospitalizations, emergency department visits, and outpatient visits.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data Sources and Analytic Sample<\/jats:title>\n                    <jats:p>Optum's de\u2010identified Clinformatics Data Mart Database (2017\u20132023) provided data on 216,205 MA beneficiaries with ESKD (359,172 beneficiary\u2010years).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Principal Findings<\/jats:title>\n                    <jats:p>\n                      Post\u2010policy, enrollees were younger, had lower comorbidity burden and lower education attainment, and were more likely to report household incomes below $40,000. Hospitalization rates were lower immediately post\u2010policy by 0.013 per beneficiary\u2010month (6% relative decline; 95% CI, \u22120.022 to \u22120.003;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). ED visits showed no immediate difference but increased over time. Outpatient visits remained largely stable.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Expanded MA eligibility was associated with a substantial shift in the ESKD MA case mix toward younger, relatively healthier, and more socioeconomically vulnerable beneficiaries. Utilization changes reflect these compositional differences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1475-6773.70150","type":"journal-article","created":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:18:46Z","timestamp":1787923126000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From Locked Out to Opting in: How the Cures Act Reshaped Medicare Advantage Utilization for Beneficiaries With End\u2010Stage Kidney Disease"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9675-6114","authenticated-orcid":false,"given":"Sih\u2010Ting","family":"Cai","sequence":"first","affiliation":[{"name":"Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3886-6144","authenticated-orcid":false,"given":"Hailemichael","family":"Shone","sequence":"additional","affiliation":[{"name":"Paul H. O'neill School of Public and Environmental Affairs, Indiana University  Bloomington Indiana USA"},{"name":"Irsay Institute, Indiana University  Bloomington Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3231-1466","authenticated-orcid":false,"given":"Kosali","family":"Simon","sequence":"additional","affiliation":[{"name":"Paul H. O'neill School of Public and Environmental Affairs, Indiana University  Bloomington Indiana USA"},{"name":"Irsay Institute, Indiana University  Bloomington Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8403-9612","authenticated-orcid":false,"given":"Daniel","family":"Polsky","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Bloomberg School of Public Health &amp; Carey Business School, Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"United States Renal Data System \u201c2022 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States (National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases) \u201daccessed May 25 2023 https:\/\/adr.usrds.org\/."},{"key":"e_1_2_10_3_1","unstructured":"Medicare Payment Advisory Commission \u201cReport to the Congress: Medicare Payment Policy (2021) \u201daccessed February 13 2022 http:\/\/www.medpac.gov\/\u2010documents\u2010\/reports."},{"key":"e_1_2_10_4_1","unstructured":"Medicare Payment Advisory Commission \u201cA Data Book: Health Care Spending and the Medicare Program July 2023 \u201daccessed February 1 2025 https:\/\/www.medpac.gov\/wp\u2010content\/uploads\/2023\/07\/July2023_MedPAC_DataBook_Sec2_SEC.pdf."},{"key":"e_1_2_10_5_1","unstructured":"S. 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