The Centers for Medicare & Medicaid Services (CMS) is trying to control ballooning Medicare costs by improving the management of care for people who are eligible for both Medicare and for Medicaid.
Medicare serves the elderly and people with disabilities. Medicaid covers the poor.
Many of the 9 million “dual eligibles” are the kinds of elderly people who could not or would not buy private long-term care insurance (LTCI) and now have to rely on the kindness of Uncle Sam and state governments to pay for their LTC services.
About 16% of Medicare enrollees and 15% of Medicaid enrollees are dual eligibles. They account for 27% of Medicare program spending and 39% iof Medicaid spending, according to Sen. Herb Kohl, D-Wis., the chairman of the Senate Special Committee on Aging.
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But Dr. Robert Berenson, an internist who’s now working as a health policy specialist at the Urban Institute, Washington, argued at a hearing that Kohl organized on dual eligibles that CMS and others may be overselling the benefits of a care coordination program now in the works, and that officials should consider reducing the size of the program.
Berenson acknowledged that the current payment system works poorly and that government agencies should be experimenting with ways to improve it.
“There have been some notable successes of statesupported programs for disabled and for duals,” Berenson said, according to a written version of his remarks.
But Berenson argued that CMS should resist the urge to put 2 million dual eligibles in new coordinated managed care plans in just a few years, as it currently hopes to do.