Fully integrated solutions should be available in all states for individuals who are enrolled in both Medicare and Medicaid, the Bipartisan Policy Center announced this week as it unveiled its policy recommendations to achieve this aim.
The report, “Integrating Medicare and Medicaid for Dual-Eligible Individuals,” represents a year-long effort to get stakeholder agreement from across the political spectrum for how to improve care for an estimated 12 million people across the United States who are eligible for both programs, the so-called dual-eligible population.
Dual-eligible beneficiaries have long suffered from a disconnect between their Medicare and Medicaid coverage, and this fragmentation drives up government spending. While dual-eligible individuals comprise only 15 percent of Medicaid enrollees, they drive 33 percent of program spending. Similarly, while accounting for only 20 percent of the Medicare population, they account for 34 percent of total Medicare spending, representing more than $300 billion in Medicare-Medicaid program expenditures annually.
Amount of Medicaid spending driven by dual-eligibles, who comprise only 15 percent of program enrollees
Integration of care between the two programs has been increasingly embraced by some states as a way to better streamline and coordinate care for dual-eligible individuals, but we still have a long way to go.
“We have been working to integrate care for this vulnerable population for decades…and less than 10 percent are in seamless fully-integrated plans,” said former Senate Majority Leader Tom Daschle, BPC Health Project Leader. “Now is the time for a comprehensive approach.”
Integrated care must have a single entity responsible for fully aligned financing, a single set of benefits, and a single point of access, BPC said.
Under the proposed solution, all states would be required to make integrated care available for dual eligible beneficiaries, and if they do not, a federal fallback that provides integrated coverage would go into place to ensure availability. The proposal also includes solutions to make it easier for people to enroll in integrated coverage — namely, people would be auto-enrolled in integrated care aligned with their existing network of providers, for example, then given the option to opt out if they so choose.
The question of how best to align and coordinate care for dual-eligible beneficiaries has become a matter of urgent concern during the pandemic as the coronavirus wages a deadlier toll on the population that tends to be elderly, disabled or managing multiple chronic conditions. A report by the Centers for Medicare and Medicaid Services found that the pandemic has disproportionately impacted dual-eligibles, many of whom live in nursing homes and long-term care facilities which have been especially hard hit. These individuals are four and a half times more likely than Medicare enrollees to be hospitalized with COVID-19.
“We began our Complex Care investment strategy just over a year ago, and despite the powerful and clear work that many people have done for decades around the dual-eligible population, it was rare to see this issue in the headlines,” Arielle Mir, Vice President of Complex Care at Arnold Ventures, said during the report’s unveiling on Monday. “Since that time, the world has turned upside down, and now the problems that you all have long documented and warned us of are overflowing in our news feeds … This report released by BPC today emerges at a critical moment. It reminds us that not only do we need to address the crisis of the hour — we must also address those long-standing system failures impacting people who are dual eligible — failures that will not be remedied with a COVID vaccine or treatment.”