Medicare Watch

Understanding Dual Eligibles and How to Address the Population’s Needs

According to an issue brief by the Kaiser Family Foundation, dual eligibles—people who are enrolled in both Medicare and Medicaid—accounted for 15 percent of Medicaid enrollees in 2007, but approximately 39 percent of the program’s spending at the national level. Medicaid spending rates vary across states, and the brief, Dual Eligibles: Medicaid Enrollment and Spending for Medicare Beneficiaries in 2007, explores the spending trends for dual eligibles by region.

In Connecticut, New Hampshire, North Dakota and Wisconsin, spending on dual eligibles accounted for over half of all Medicaid spending, whereas in Illinois, Texas, Georgia and Nevada spending for duals represented about 30 percent of those states’ total Medicaid expenses.

Nationwide, Medicare premiums and cost-sharing made up 24 percent of Medicaid spending on dual eligibles. Approximately 70 percent of Medicaid spending on duals was dedicated to long-term care services, which are not covered by Medicare. This amount, however, varied widely by state, ranging from 52 percent in Arkansas to 89 percent in North Dakota.

As the report notes, due to the extensive needs of this fragile population, there is increased attention on how to best coordinate care and improve health outcomes while also curbing costs at both the federal and state levels. However, given the vulnerability and diversity of this population, it is important that models of care and delivery systems contain adequate consumer protections. The Affordable Care Act (ACA) creates two new initiatives through the Centers for Medicare & Medicaid Services (CMS) that will examine these issues: the Center for Medicare and Medicaid Innovation (CMMI) and the Federal Coordinated Health Care Office (FCHCO). Last week CMS announced the availability of funding to states to support the design of innovative delivery and payment models. CMS may award contracts of up to $1 million each to 15 states. According to CMS, “The primary outcome of the initial design period will be a demonstration proposal that describes how the State would structure, implement, and evaluate a model aimed at improving the quality, coordination, and cost effectiveness of care for dual eligible individuals.”

Read the Kaiser Report Dual Eligibles: Medicaid Enrollment and Spending for Medicare Beneficiaries in 2007.

Read more about the CMS’s proposal solicitation, “State Demonstrations to Integrate Care for Dual Eligible Individuals”.

Millions of Baby Boomers Will Benefit from the Affordable Care Act

Baby boomers are among those who will particularly benefit from the Affordable Care Act (ACA), according to Realizing Health Reform’s Potential: Adults Ages 50-64 and the Affordable Care Act of 2010, a new report released by the Commonwealth Fund. According to the report, 75 percent of uninsured individuals aged 50 to 64 do not get needed care because of cost and that seven out of ten baby boomers who are uninsured or underinsured reported having problems paying their medical bills. But the ACA will help these individuals better afford care. The ACA expands Medicaid coverage to those individuals with incomes at or below 133 percent of the federal poverty level, and also eliminates the consideration of assets in eligibility determinations. For those ineligible for Medicaid, the law creates a sliding scale of government subsidies based on income that will help individuals buy coverage through state-run exchanges. 6.8 million of the estimated 8.6 million people aged 50-64 who were uninsured in 2009 would gain subsidized insurance through Medicaid or plans offered in exchanges.

Health-related out-of-pocket costs are so high for the 50- to 64-year-olds who have insurance that the report estimates roughly 9.7 million of them are underinsured, and that high costs may still act as a barrier to care. However, reforms included in the ACA, such as the elimination of life-time limits on coverage, the development of essential benefit standards and limits on out-of-pocket spending, will make care for this population more affordable.

Read Realizing Health Reform’s Potential: Adults Ages 50-64 and the Affordable Care Act of 2010.

Medicare Reminder

Time is running out for consumers to make unrestricted changes to their Medicare health and drug coverage. The following are important questions to ask before the Fall Open Enrollment Period ends on December 31:

What are my Medicare coverage options?

Can I change my Medicare health plan at any time?

What insurance can I buy to fill gaps in Original Medicare?

Can I buy a Medigap policy at any time?

How do I compare Medicare private drug plans?

Do I need to review my Medicare prescription drug plan choice every year?

Learn more at www.MedicareInteractive.org.

Spotlight

President Obama has signed into law the Medicare and Medicaid Extenders Act, which protects Medicare consumers’ access to care. The law delays steep cuts in Medicare payments to physicians and extends the Qualified Individual (QI) Program and the Medicare therapy caps exception process.

Read more.