Medicare, not Medicaid, should take full responsibility for the population of patients eligible for both programs (PDF), says a new report funded by the Robert Wood Johnson Foundation.
Medicare should take lead in covering dual-eligibles, report says
The study from researchers at the Urban Institute suggests that states' expenditures on the dual-eligible population focus on long-term supports and services, not medical care.
“Although states have developed managed care for Medicaid's younger enrollees, they lack experience in managing dual-eligibles' medical care, and face continued incentives to substitute federal Medicare for state Medicaid spending, in order to control their expenditures,” the study said. It also noted that most Medicaid managed-care plans lack both the experience and capacity to handle dual-eligible patients.
Another issue, according to the study, is that as Medicare beneficiaries, dual-eligible patients are entitled to some consumer protections that are not available to low-income Medicaid beneficiaries. “Without substantial oversight, shifting responsibility for their Medicare services to Medicaid programs may forfeit these protections and create financial incentives to limit care for high-need beneficiaries.”
The report noted that the Medicare program paid about $256 billion, or 80%, of the total $319.5 billion spent on the dual-eligible population in 2011. And while states pay for the remaining 20% on dual-eligibles, very little of that goes toward acute care, where researchers say savings and quality improvement are achievable. “These services are Medicare's responsibility,” the study said, “and the savings are Medicare's to pursue. Allowing state initiatives to absolve Medicare of responsibility for improving the quality and efficiency of the care it finances simply does not make sense.”
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.