{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T22:15:47Z","timestamp":1777932947607,"version":"3.51.4"},"reference-count":17,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T00:00:00Z","timestamp":1765065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,12,7]],"date-time":"2025-12-07T00:00:00Z","timestamp":1765065600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Med Care Res Rev"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>Identifying dual-eligible beneficiaries who use Medicaid-funded long-term services and supports (LTSS) is difficult, hindering efforts to monitor use and improve quality. We demonstrate a strategy that uses only Medicare data to identify nursing home (NH) users and Medicaid home-and-community-based-service (HCBS) waiver participants by leveraging the fact that these groups exclusively qualify for zero cost-sharing in Part D. In a multistate cohort of low-income older adults, we identified Part D LTSS beneficiaries (dual-eligible beneficiaries with zero Part D cost-sharing) in Medicare enrollment records and verified LTSS use in NH assessments and Medicaid HCBS data. Over 96% of NH\/HCBS waiver users in MDS or Medicaid data were correctly identified as Part D LTSS beneficiaries, and 93% of beneficiaries without NH or HCBS waiver use were accurately identified as not being Part D LTSS beneficiaries. Leveraging Part D data could support more timely evidence on quality and outcomes for dual-eligible LTSS users.<\/jats:p>","DOI":"10.1177\/10775587251394772","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T07:11:32Z","timestamp":1765177892000},"page":"227-235","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Identifying Dual-Eligible Beneficiaries With Long-Term Services and Supports Use in Medicare Enrollment Data"],"prefix":"10.1177","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9400-0575","authenticated-orcid":false,"given":"Laura M.","family":"Keohane","sequence":"first","affiliation":[{"name":"Vanderbilt University School of Medicine, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6430-4482","authenticated-orcid":false,"given":"Emmaline","family":"Keesee","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1217-8415","authenticated-orcid":false,"given":"Chanee D.","family":"Fabius","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David G.","family":"Stevenson","sequence":"additional","affiliation":[{"name":"Vanderbilt University School of Medicine, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,12,7]]},"reference":[{"key":"e_1_3_3_2_1","unstructured":"Centers for Medicare & Medicaid Services. (2020). Medicare-Medicaid linked enrollee analytic data source (MMLEADS) PUF. https:\/\/www.cms.gov\/research-statistics-data-and-systems\/downloadable-public-use-files\/mmleads"},{"key":"e_1_3_3_3_1","unstructured":"Chronic Conditions Warehouse. (2022). 27 CCW Chronic Conditions Algorithms: MBSF_CC_{YYYY} file. Center for Medicare and Medicaid Services. https:\/\/www2.ccwdata.org\/documents\/10280\/19139421\/ccw-chronic-condition-algorithms.pdf"},{"key":"e_1_3_3_4_1","doi-asserted-by":"crossref","unstructured":"Fabius C. D. Cornell P. Y. Zhang W. Thomas K. S. (2022). State Medicaid financing and access to large assisted living settings for Medicare\u2013Medicaid dual-eligibles. Medical Care Research and Review 79(1) 69\u201377. https:\/\/doi.org\/10.1177\/1077558720987666","DOI":"10.1177\/1077558720987666"},{"key":"e_1_3_3_5_1","doi-asserted-by":"crossref","unstructured":"Figueroa J. F. Joynt Maddox K. E. Beaulieu N. Wild R. C. Jha A. K. (2017). Concentration of potentially preventable spending among high-cost Medicare subpopulations: An observational study. Annals of Internal Medicine 167(10) 706\u2013713. https:\/\/doi.org\/10.7326\/M17-0767","DOI":"10.7326\/M17-0767"},{"key":"e_1_3_3_6_1","doi-asserted-by":"crossref","unstructured":"Gorges R. J. Konetzka R. T. (2020). Staffing levels and COVID-19 cases and outbreaks in U.S. nursing homes. Journal of the American Geriatrics Society 68(11) 2462\u20132466. https:\/\/doi.org\/10.1111\/jgs.16787","DOI":"10.1111\/jgs.16787"},{"key":"e_1_3_3_7_1","doi-asserted-by":"crossref","unstructured":"Grodstein F. Chang C.-H. Capuano A. W. Power M. C. Marquez D. X. Barnes L. L. Bennett D. A. James B. D. Bynum J. P. W. (2022). Identification of dementia in recent Medicare claims data compared with rigorous clinical assessments. The Journals of Gerontology: Series A 77(6) 1272\u20131278. https:\/\/doi.org\/10.1093\/gerona\/glab377","DOI":"10.1093\/gerona\/glab377"},{"key":"e_1_3_3_8_1","unstructured":"Kaiser Family Foundation. (n.d.). Distribution of certified nursing facility residents by primary payer source. https:\/\/www.kff.org\/other\/state-indicator\/distribution-of-certified-nursing-facilities-by-primary-payer-source\/"},{"key":"e_1_3_3_9_1","doi-asserted-by":"crossref","unstructured":"Kane R. L. Wysocki A. Parashuram S. Shippee T. Lum T. (2013). Effect of long-term care use on Medicare and Medicaid expenditures for dual eligible and non-dual eligible elderly beneficiaries. Medicare & Medicaid Research Review 3(3) mmrr.003.03.a05. https:\/\/doi.org\/10.5600\/mmrr.003.03.a05","DOI":"10.5600\/mmrr.003.03.a05"},{"key":"e_1_3_3_10_1","doi-asserted-by":"crossref","unstructured":"Kaye H. S. Caldwell J. (2023). Excess deaths of Medicaid home and community-based services recipients during COVID-19. Health Affairs 42(1) 115\u2013120. https:\/\/doi.org\/10.1377\/hlthaff.2022.00457","DOI":"10.1377\/hlthaff.2022.00457"},{"key":"e_1_3_3_11_1","doi-asserted-by":"crossref","unstructured":"Keohane L. M. Stevenson D. G. Freed S. Thapa S. Stewart L. Buntin M. B. (2018). Trends in Medicare fee-for-service spending growth for dual-eligible beneficiaries 2007\u201315. Health Affairs 37(8) 1265\u20131273. https:\/\/doi.org\/10.1377\/hlthaff.2018.0143","DOI":"10.1377\/hlthaff.2018.0143"},{"key":"e_1_3_3_12_1","doi-asserted-by":"crossref","unstructured":"Konetzka R. T. Karon S. L. Potter D. E. B. (2012). Users of Medicaid home and community-based services are especially vulnerable to costly avoidable hospital admissions. Health Affairs 31(6) 1167\u20131175. https:\/\/doi.org\/10.1377\/hlthaff.2011.0902","DOI":"10.1377\/hlthaff.2011.0902"},{"key":"e_1_3_3_13_1","unstructured":"Medicare Payment Advisory Commission & Medicaid and CHIP Payment and Access Commission. (2024). Data book: Beneficiaries dually eligible for Medicare and Medicaid. https:\/\/www.macpac.gov\/wp-content\/uploads\/2024\/01\/Jan24_MedPAC_MACPAC_DualsDataBook-508.pdf"},{"key":"e_1_3_3_14_1","unstructured":"Musumeci M. Chidambaram P. Watts M. O. (2019). Medicaid home and community-based services enrollment and spending. Kaiser Family Foundation. https:\/\/www.kff.org\/medicaid\/issue-brief\/medicaid-home-and-community-based-services-enrollment-and-spending\/"},{"key":"e_1_3_3_15_1","doi-asserted-by":"crossref","unstructured":"Signorello L. B. Hargreaves M. K. Blot W. J. (2010). The Southern Community Cohort Study: Investigating health disparities. Journal of Health Care for the Poor and Underserved 21(1) 26\u201337. https:\/\/doi.org\/10.1353\/hpu.0.0245","DOI":"10.1353\/hpu.0.0245"},{"key":"e_1_3_3_16_1","doi-asserted-by":"crossref","unstructured":"Skira M. M. Wang S. Konetzka R. T. (2022). Trends in Medicaid home and community-based services waivers for older adults. 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