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Advocates Worry States Are Moving Too Fast On Dual Eligibles

Some states likely will begin testing new ways to care for people who qualify for both Medicare and Medicaid early next year—a timeline that has some advocates urging officials to slow down.

Finding high-quality, cost-effective ways to care for the 9 million people known as “dual eligibles” is among the brass rings of health policy.  The population includes some of the sickest and poorest Americans who must navigate a fragmented system that can impede their care. Managing their care is important because they account for a disproportionate share of health spending — they account for approximately 20 percent of Medicare’s beneficiaries, for instance, but 31 percent of its spending, and 15% of Medicaid beneficiaries, but nearly 40 percent of that program’s spending, according to Melanie Bella, the director of the Medicare-Medicaid Coordination Office.

Bella said Tuesday that more than half the states have expressed interest in testing new models of care for dual eligibles. Twenty-five states have posted their plans for public comment, and seven already have submitted their plans to the federal government. The first wave of states is expected to go live with their plans in January 2013, according to Bella, who spoke at a panel discussion on dual eligibles held by the American Enterprise Institute.

However, Patricia Nemore, an attorney at the Center for Medicare Advocacy, said advocates are nervous about whether the plans do enough to protect dual eligibles, and more time would help ensure those concerns are addressed.  The states may pledge to protect beneficiaries in a general sense, but their plans need to be concrete, she said.

Bella said that questions about how fast to move are legitimate, but that it’s important for officials to act with urgency to get new models off the ground.

“Everywhere I go I get a group of people telling me we’re moving too slow and a group of people telling me we’re moving too fast,” she said.

This article was produced by Kaiser Health News with support from
The SCAN Foundation