Christie Provost Peters
There are over 8 million beneficiaries who are dually eligible for Medicare and Medicaid services, and their health status is quite diverse. Many of these individuals have substantial and costly medical and long-term services and support needs, but some have only limited needs. The variation in duals’ health status can present challenges to providers and policymakers trying to meet their needs and contain costs in both the Medicare and Medicaid programs. This Forum session examined the diversity of the dually eligible population and the challenges Medicare and Medicaid encounter serving this beneficiary group—especially the high-cost, high-needs beneficiaries. The benefits and challenges of coordinating care across Medicare and Medicaid providers, including how different program and provider incentives can affect duals’ care and costs, were discussed. Speakers highlighted current approaches to integrate care and financing (such as Special Needs Plans [known as SNPs] and the Program of All-Inclusive Care for the Elderly [known as PACE]) and their effect on duals’ care, examined some alternative models states are pursuing to coordinate services and control spending, and highlighted the challenges and concerns they present at the federal level. Speakers also addressed the challenges dually eligible beneficiaries face in receiving services from both Medicare and Medicaid and opportunities for the new Federal Coordinated Health Care Office created under the Patient Protection and Affordable Care Act. (P.L. 111-148).
Mark Miller, PhD, Executive Director, Medicare Payment Advisory Commission; Melanie Bella, Senior Vice President for Policy and Operations,Center for Health Care Strategies, Inc.; Hilary Dalin, Associate Director, My Medicare Matters, National Council on Aging
For more information on dual eligibles, see Medicare Payment Advisory Commission, "Coordinating the Care of the Dual Eligibles," chapter 5 in Aligning Incentives in Medicare, June 2010.