The Bipartisan Policy Center, a Washington, D.C.-based nonpartisan think tank, called on Congress and states to take steps to integrate Medicare and Medicaid for the vulnerable patients eligible for both programs.
Integrating the safety-net programs would improve millions of dually eligible individuals' healthcare experience, health outcomes and well-being, while potentially driving cost savings from fewer hospitalizations, readmissions and emergency department visits, the organization wrote in a report published Monday.
According to the CMS, there were 12.2 million people enrolled in both Medicare and Medicaid in 2019. Dual eligibles generally have multiple chronic conditions and account for disproportionate share of healthcare spending. Last year, CMS Administrator Seema Verma said that less than 10% of these individuals received integrated services from Medicare and Medicaid. That's despite the existence of several care delivery and payment models that support integration between the programs.
To ensure that dual eligible have access to integrated care, the Bipartisan Policy Center recommended that Congress define what full integration of Medicare and Medicaid services should look like. The organization recommended that Congress require integration to have fully aligned financing, a single set of benefits, and a single health plan offering these benefits and handling processes for enrollment, grievances and appeals.
The organization urged Congress to require states to provide fully integrated Medicare and Medicaid services, either by integrating the care themselves or through a federal fallback option. The Bipartisan Policy Center recommended that states integrate services within eight years of the enactment of federal legislation. It calls on Congress to provide states with financial and technical assistance, and give HHS the authority to create a shared savings program for integrated care.
Congress should create a federal fallback program to be implemented in states that chose not to implement their own integrated care program, and require Medicare Advantage insurers to offer integrated health plan options in areas where they already offer coverage, the report states.
Among other recommendations, the Bipartisan Policy Center said CMS' Medicare-Medicaid coordination office should be given direct funding and full regulatory authority for all programs serving dually eligible individuals, so as to boost staffing and resources. Meanwhile, HHS should have waiver authority to align the administrative differences in Medicare and Medicaid.
Other recommendations included in the report are meant to ensure that integrated plans adhere to uniform standards, and that all dual eligible are able to enroll in the plans.
