Guaranteeing integrated care for dual eligible individuals
- Collection:
- Health Policy and Services Research
- Contributor(s):
- Bipartisan Policy Center, issuing body.
- Publication:
- Washington, DC : Bipartisan Policy Center, November 2021
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Delivery of Health Care, Integrated Dual MEDICAID MEDICARE Eligibility Health Policy -- legislation & jurisprudence United States
- Genre(s):
- Technical Report
- Abstract:
- When Medicare and Medicaid services are not integrated, dual eligible individuals must navigate separate programs to receive health care, long-term services and supports, and other services. In states that contract with managed care plans to deliver Medicaid services, some of which may separately provide, or “carve out,” certain benefits, a dual eligible individual must navigate not only separate programs but also multiple Medicaid plans. Individuals may choose to receive Medicare benefits through managed care or fee-for-service. They may obtain some Medicaid services on a fee-for-service basis but may be required to enroll in one or more Medicaid managed care plans for other services. In extreme cases, a dual eligible individual could be enrolled in five separate programs or plans to get the full range of Medicare and Medicaid benefits. These programs include: 1. A Medicare Advantage (MA) plan (or fee-for-service Medicare) for Medicare-covered services. 2. A Medicaid managed care plan for behavioral health services. 3. A Medicaid managed care plan for dental services. 4. A Medicaid managed care plan for long-term services and supports. 5. Medicaid fee-for-service or yet another Medicaid managed care plan for health services not covered by Medicare or one of the managed care carve-out plans listed above. The current system makes it extremely difficult for health care providers to deliver patient-centered care, and incredibly challenging for beneficiaries and their families to navigate care, appeal a coverage decision, or determine who to call for help. BPC believes that states are best positioned to integrate Medicare and Medicaid services for two reasons. First, states have decades of experience contracting for home and community-based services, which are financed through Medicaid. Second, although some beneficiaries are relatively healthy, others have complex medical conditions, have mental health or substance use disorders, are homeless, or experience a combination of these issues. Accordingly, they may need providers with special training and experience in delivering services and addressing social needs. Many patient advocates believe that these health care providers are best identified at the state level. However, federal intervention is needed when states decide not to integrate services for this vulnerable population.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file 47 pages)) : illustrations
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918333788306676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918333788306676