Low income disabled patients say their care has improved under a federal experiment that allows states test ways to better manage benefits and care for people dually eligible for Medicare and Medicaid, according to a federal audit.
The report released on March 21 was compiled by the research organization RTI International on behalf of the CMS to evaluate the experiment known as the Financial Alignment Initiative.
As part of the experiment, states implemented new care coordination approaches designed to integrate care across medical, long term supports and services and behavioral health systems.
RTI complied the report based on feedback from site visit interviews with state officials, consumer advocates, CMS staff and various other demonstration stakeholders. However, the findings about patient satisfaction were largely anecdotal and based on feedback from focus groups and state beneficiary surveys.
Patients told the researches that the experiment helped them gain quicker access to care thanks to care managers. Future reports by RTI are expected to provide more concrete analysis on if the experiment is working or not.
But states have been having trouble getting the experiments off the ground as they struggle to hire and train care coordinators in time to serve duals enrolled in the program. The states also have had issues locating and contacting Medicare-Medicaid enrollees that are passively enrolled into the programs.
To date, there are 14 dual demonstrations in 13 states. Most of the efforts were launched under an Affordable Care Act provision, though Minnesota received permission to create its own unique approach for duals' care. Duals often have chronic conditions and require costly care.
Even though dual-eligible beneficiaries only make up 13% of the population, they account for 40% of total Medicaid spending and 27% of total Medicare spending. Experts say the lack of coordination results in poor quality care and unnecessarily high costs, and addressing that issue is one of the biggest opportunities for Medicaid and Medicare savings.
Despite originating under the ACA, the experiment is not a budget-related provision and can't be repealed without Democrat support. The Trump administration also showed some support to the program in February by offering participating states to continue the effort for additional years.