LTCI Watch: Dual eligibles

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.