The U.S. Department of Health and Human Services announced on Wednesday a program to better coordinate care for nine million dual-eligibles, or beneficiaries enrolled in both Medicare and Medicaid.
Currently, low-income seniors and people with disabilities must navigate two separate programs: Medicare for coverage of basic acute health care services and drugs, and Medicaid for coverage of supplemental benefits such as long-term care supports and services. Medicaid also provides help with Medicare premiums and cost-sharing for those who need additional assistance.
Medicare and Medicaid spend $300 billion each year to care for dual-eligibles. About 60% of dual-eligibles have multiple chronic conditions and 43% have at least one mental or cognitive impairment.
The Alignment Initiative will be led by the federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office), which was created by the Affordable Care Act to help make the two programs work together more effectively to improve patient care and lower costs.
The ACA directs the Medicare-Medicaid Coordination Office to identify "existing rules that may be outmoded, ineffective, insufficient, or excessively burdensome, and to modify, streamline, expand, or repeal them." As a first step the office is addressing conflicting requirements between Medicaid and Medicare that could create barriers to high quality, seamless, and cost-effective care for dual eligibles. For example, Medicaid and Medicare have different coverage standards for accessing durable medical equipment.
The office is seeking input in six areas: care coordination, fee-for-service benefits, prescription drugs, cost sharing, enrollment and appeals.