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Study Finds Discrepancies in Risk Adjustment Scores for Dual-Enrolled Veterans in Medicaid and VA Healthcare

Strategic Insights

— 1 min read

New research has shed light on the discrepancies in risk adjustment scores for dual-enrolled veterans in Medicaid and the Veterans Health Administration (VA). The study, conducted by researchers from the Center for Innovations in Quality, Effectiveness and Safety, aimed to measure these discrepancies using only Medicaid or VA diagnoses for veterans dually enrolled in both programs. The findings have significant implications for the quality and effectiveness of healthcare services for these vulnerable populations.

Key Takeaways:

  • The study compared the number and overlap of annual diagnoses derived from VA and Medicaid data for 183,018 dual-enrolled veterans with service-connected disabilities and 219,977 dual-enrolled veterans without service-connected disabilities.
  • On average, service-connected individuals had 9.1 fewer diagnoses from Medicaid-only data than from VA-only data, while non-service-connected veterans had 5.0 fewer diagnoses.
  • Intraclass correlations between VA-only data and combined VA-Medicaid scores were higher for Charlson (0.816 vs. 0.591 for service-connected, 0.722 vs. 0.638 for non-service-connected) and Elixhauser (0.818 vs. 0.609 for service-connected, 0.723 to 0.702 non-service-connected) scores.
  • Medicaid-only scores had higher correlations for CMS V21 (0.756 vs. 0.666 for service-connected, 0.795 to 0.542 for non-service-connected) scores.
  • The researchers concluded that combining records to calculate disease burden for dual-enrolled veterans is essential to ensure complete capture of risk.

Statistics:

  • 183,018 dual-enrolled veterans with service-connected disabilities were included in the study, representing 405,318 person-years.
  • 219,977 dual-enrolled veterans without service-connected disabilities were included, representing 531,948 person-years.
  • Average number of diagnoses for service-connected individuals: 9.1 fewer from Medicaid-only data than from VA-only data.
  • Average number of diagnoses for non-service-connected veterans: 5.0 fewer from Medicaid-only data than from VA-only data.

Sources:

  • "Comparison of Number and Overlap of Diagnostic Information for Risk Adjustment for Dually Enrolled Veterans in Medicaid." Health Services Research, 2025.
  • "Study Findings from Michael E. DeBakey Veterans Affairs Medical Center Provide New Insights into Veterans Health (Comparison of Number and Overlap of Diagnostic Information for Risk Adjustment for Dually Enrolled Veterans in Medicaid)." Managed Care Weekly Digest. September 15, 2025; p 176.

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