Reports of low enrollment so far have not dimmed the Obama administration's optimism about its ambitious demonstration program to improve coordination of care for millions of low-income and disabled Americans who are dually eligible for Medicaid and Medicare.
The Affordable Care Act authorized demonstrations to improve care and reduce costs for the more than 9 million dual-eligible beneficiaries, many of whom have severe chronic conditions and physical or behavioral disabilities.
Of the 1.7 million people eligible to participate in the 11 states with demonstrations, 26%, or 450,844, had signed up as of May 1, according to Community Catalyst, a consumer advocacy group based in Massachusetts.
“I think we're learning as we go,” Tim Engelhardt, acting director of the CMS' Medicare-Medicaid Coordination Office, said at the Medicaid and CHIP Payment and Access Commission meeting May 14.
Under the demonstration, participating states are responsible for coordinating Medicare and Medicaid benefits and spending for dual-eligible beneficiaries through contracts with private managed-care plans. The states receive a capitated payment combining Medicaid and Medicare, minus agreed-upon savings. The plans generally are responsible for providing the full range of patient care, including long-term care, though each state's program is somewhat different.
Dual-eligible beneficiaries make up only 13% of the population enrolled in both programs, but they account for 40% of total Medicaid spending and 27% of total Medicare spending. Experts say the current lack of program coordination results in poor quality care and unnecessarily high costs.
Engelhardt noted that this is the largest number of dual-eligible beneficiaries who have ever received full coordinated care. “If we end up spending what we're spending now, but we improve quality of care, I don't know if that's a failure,” Engelhardt said in an interview.