Key policy changes could significantly improve the integration of care for people that are eligible for both Medicare and Medicaid, the Medicaid and CHIP Payment and Access Commission said Monday in its annual report to Congress.
MACPAC said CMS should loosen enrollment restrictions for so-called "dual-eligibles" by creating an exception to the special-enrollment period so they can enroll on a continuous, monthly basis. Likewise, Congress should give states more federal funding to develop Medicare expertise and to put integrated care models into practice.
Congress should also require states to use the same definitions of income, household size and assets that the Social Security Administration uses to determine eligibility for the Part D low-income subsidy program when states determine eligibility for Medicare Savings Programs. Under MACPAC's proposal, the Social Security Administration would have to share that information with states each year, which would simplify eligibility redeterminations for both states and beneficiaries.
MACPAC recognizes "the pandemic has pushed other issues to the back burner (but) these issues will still be of concern when the pandemic is over," MACPAC Chair Melanie Bella said in the commission's letter to Congress.
The commission thinks the changes would improve the health outcomes of dual-eligibles and reduce federal and state healthcare spending by making it easier for eligible individuals to enroll—and stay enrolled—in the programs they qualify for and, in turn, improve care integration.
Dual-eligibles make up a disproportionate share of Medicaid and Medicare service use and spending.
The advisory panel also made two recommendations to make sure Medicaid is a payer of last resort. It recommended that CMS help coordinate eligibility and coverage information among state Medicaid agencies and the Defense Department's Tricare program. The commission also said Congress should force the Defense Department to adopt the same third-party liability policies as other health insurers.
According to MACPAC, Tricare doesn't coordinate "benefits with state Medicaid programs, resulting in a cost shift at the federal level from the DoD to the U.S. Department of Health and Human Services and from the federal government to states."
About 867,000 people enrolled in Medicaid receive their primary coverage through Tricare, including roughly 220,000 children. It's the largest source of third-party, public coverage for Medicaid-enrolled children besides disability.
State and federal Medicaid savings from third-party payers totaled $13.6 billion in 2011, according to MACPAC. That was nearly a $10 billion increase from 2001.
MACPAC's report also analyzes Medicaid's role in maternal health, including increased mortality and morbidity among pregnant women and new mothers and the effects of substance use disorder on pregnant women and newborns covered by Medicaid. The commission found that while state Medicaid programs can tailor benefits to pregnant women with substance use disorder and infants with neonatal abstinence syndrome, few states do it.