The New York State Health Foundation (NYSHealth) has released a report about the 700,000 people in the state who are enrolled in both Medicaid and Medicare, with the goal of improving the coordination and integration of care.
Mathematica Policy Research completed the report that was funded by NYSHealth and titled, “Integrating Care for Dual Eligibles in New York: Issues and Options.”
According to a summary of the report, “These ‘dual eligibles’ are among the State's costliest and most complex Medicaid beneficiaries. Developments at both the Federal and State levels provide opportunities to better coordinate care for this population.”
These developments include an initiative by Gov. Andrew Cuomo in January 2011 to appoint a Medicaid Redesign Team (MRT), and several legislative measures that followed.
Dual eligibles make up 15% of Medicaid beneficiaries and 18% of Medicare enrollees, but account for 39% of Medicaid expenditures and 31% of Medicare expenditures, according to the report.
“Because they have greater care needs than the average Medicaid enrollee, dual eligibles often require a complex array of services from multiple providers. Managed care organizations have limited experience in serving this population, and dual eligibles themselves are concerned about potential restrictions to provider access under managed care,” the report explained.
The report examined dual eligible characteristics, care needs, costs and service delivery options and offered recommendations for integration between Medicaid and Medicare services.
The recommendations include: using the Federal demonstration to support and enhance State initiatives, requiring greater integration of services into capitated managed care programs and using the Centers for Medicaid and Medicare Services (CMS) ﬁnancial alignment models to help ﬁnance more integrated beneﬁts for dual eligibles.
The report also recommends continuing and expanding stakeholder engagement and consultation and using health homes funding from the Federal Affordable Care Act of 2010 to cover initial Medicaid care coordination costs.
Almost two-thirds of dual eligibles are over 65 years of age. All have a low income or none at all. About 40% have a significant behavioral or cognitive health condition, the report said.
The report states, “These ‘dual eligibles’ and their families, health care providers, and those who operate the two programs are continually challenged by an intricate maze of overlapping and conﬂicting programs and services, and by the inefﬁciency, fragmentation, and duplication of services that drives up overall costs for both programs… Better coordination and integration of care for dual eligibles could save State and Federal dollars and substantially improve the quality of care for this diverse and vulnerable population.”
To read the report visit http://www.nyshealthfoundation.org/userfiles/file/NYSHealth_Duals(1).pdf.
This article was published in the April 2012 issue of Able News.