Medicare/Medicaid Dual Eligibles May Be in For Health Plan Change

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Tests are underway in up to 26 states to move as many as 3 million “dual eligibles” — people who receive both Medicare and Medicaid — into managed-care health plans.

Low-income seniors on Medicare who also receive Medicaid services should be vigilant in checking their health plans in the coming months. This advice comes from the Senior Citizens League (TSCL), one of the nation's largest nonpartisan seniors groups. Tests are underway in up to 26 states to move as many as 3 million “dual eligibles” — people who receive both Medicare and Medicaid — into managed-care health plans. The object is to improve healthcare and lower government spending.

“But the time is coming when the states and federal government will be under urgent pressure to cut Medicaid and Medicare costs,” says TSCL Chairman, Larry Hyland. “TSCL is concerned that if states and the federal government don’t design and implement the changes the right way, beneficiaries’ may lose access to medically necessary care and quality.”

Low-income seniors and disabled adults who qualify for benefits under both Medicare and Medicaid frequently have multiple chronic health problems, and more than half have cognitive or mental impairments. More than half of dual eligibles also have annual incomes of less than $10,000, and are more likely to receive nursing home care. Concerns have been raised that health plans may not have adequate capacity to handle enrollment of large numbers of dual eligibles en masse in 2013. In addition, the Medicare Payment Advisory Commission (MedPac) has said that only a limited number of health plans have any experience managing benefits for this complex population.

“That combination elevates the risk of disruptions to care, and unexpected, uncovered costs — two problems that could plague seniors shifted to new managed-care plans,” Hyland says. Most states are expected to “passively enroll” beneficiaries into the plans requiring beneficiaries to take the initiative to opt out. “It is too early to know what type of choices those wishing to opt out will have,” Hyland notes. “Without a strong notification and education process, many of the affected dual eligibles may not be aware, or understand, that they have new health coverage, ” he says. “A new health plan can mean a change of doctor if their former providers don’t participate,” Hyland explains.

TSCL believes that beneficiaries need to maintain the freedom to choose their plan, their providers, and how they get their care. “We urge CMS and states to ensure a thorough beneficiary education process and have provisions that allow care with existing providers, especially during the transition,” Hyland says.

With about 1 million supporters, The Senior Citizens League is one of the nation's largest nonpartisan seniors groups. Located just outside Washington, D.C., its mission is to promote and assist members and supporters, to educate and alert senior citizens about their rights and freedoms as U.S. Citizens, and to protect and defend the benefits senior citizens have earned and paid for. The Senior Citizens League is a proud affiliate of The Retired Enlisted Association.

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Shannon Benton
The Senior Citizens League
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