As part of healthcare reform, the Center for Medicare and Medicaid Service (CMS) has been asked to identify new ways to manage health care for people who are eligible for both Medicare and Medicaid, known as dual eligibles. Over the last two years, 26 states have submitted plans describing how they would create programs to better and more efficiently care for their state's dual eligible population.
About 9 million people are dually eligible for Medicare and Medicaid, and they are one of the country's most vulnerable populations. They are generally in poorer health than the average Medicare beneficiary, with higher rates of conditions such as diabetes, mental illness, and Alzheimer's disease. Dual eligibles rely on Medicare to cover medical services such as prescription drugs and hospital visits, and qualify for Medicaid benefits that help them pay for these services and others (which vary from state to state).
Ensuring that dual eligible individuals receive a high quality of care is absolutely essential, but it is by no means simple. "Reorganizing the care of such a vulnerable and complex population is no easy task, and the details matter. Coordination efforts must be carried out with patient interests in mind, and a focus on expanding access and choice while minimizing disruptions to their health services," says Laurie Martinelli, Executive Director of the National Alliance on Mental Illness of Massachusetts. CMS is concerned that current efforts to overhaul the management of dual eligibles through these state demonstration programs could negatively impact the access to important medicines and quality of the health care these patients receive.
Why? State demonstration programs involve millions of patients and are being implemented at a fast pace. So, speedy implementation might disrupt the care that these patients are able to get, while also raising some doubt about how well CMS is able to monitor the programs so that patients' health is not put at risk. Also, allowing each state to set different standards could fundamentally change dual eligibles' health care by limiting choice of health plans and access to care in their state. Additionally, several states are planning to eliminate or weaken the use of Medicare Part D for this population, limiting patients' choice of the medicines that work best for their health problems.
Improving the quality of care dual eligibles receive is very important, and making the management of their care more efficient and cost-effective is a worthwhile goal. However, we believe that any changes to dual eligible programs must be made carefully, without disrupting patients' care or limiting their access to medicines, and we will support policies that preserve choice and access for dual eligible patients.