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LTCI Watch: Dual eligibles

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The House of Delegates at the American Medical Association (AMA) recently approved a report talking about how doctors want the federal government to handle programs for “dual eligibles,” or people who are eligible both for Medicare and Medicaid.

In theory, Medicare is a federal benefit program for the elderly and disabled. It is intended to be a state program for the poor.

In practice, some older people make themselves artificially poor through “Medicaid planning” efforts so they can qualify for Medicaid nursing home benefits.

The AMA dual eligible coordination report contains many recommendations that most people at commercial acute-care health insurers and long-term care insurance (LTCI) providers could probably endorse.

One recommendation, for example, is that delivery and payment reform should involve actively practicing physicians and take into consideration the diverse patient population and local area resources. Another provision calls for states and federal agencies to iron out the current conflicts between the Medicare and Medicaid programs. But yet another provision calls for all states with coordination programs to develop forms and processes to help patients “opt out” of managed care programs for dual eligibles.

On the one hand: That sounds nice.

On the other hand: Uh, it looks as if Medicare and Medicaid are going broke. Maybe this is not the best time to emphasize patient choice for the sake of offering patient choice?

It seems as if another consideration is that the people who actually engage in Medicaid planning — and I understand that this is a controversial topic, and that some would say that true Medicaid planning by the genuinely solvent is much less common than critics contend — really ought to “be happy with what they get and not get upset,” not complain if they have to go to a provider who meets federal quality and accessibility standards but is not the provider they’d really like to see.

Beggars who are beggars because they hired a lawyer to help them put their assets in trusts should not be choosers.  

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