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HHS Seeks Comments on Dual-Eligibles

Margaret Dick Tocknell, for HealthLeaders Media, May 13, 2011

The U.S. Department of Health and Human Services announced on Wednesday a program to better coordinate care for nine million dual-eligibles, or beneficiaries enrolled in both Medicare and Medicaid.

Currently, low-income seniors and people with disabilities must navigate two separate programs: Medicare for coverage of basic acute health care services and drugs, and Medicaid for coverage of supplemental benefits such as long-term care supports and services. Medicaid also provides help with Medicare premiums and cost-sharing for those who need additional assistance.

Medicare and Medicaid spend $300 billion each year to care for dual-eligibles. About 60% of dual-eligibles have multiple chronic conditions and 43% have at least one mental or cognitive impairment.

The Alignment Initiative will be led by the federal Coordinated Health Care Office (Medicare-Medicaid Coordination Office), which was created by the Affordable Care Act to help make the two programs work together more effectively to improve patient care and lower costs.

The ACA directs the Medicare-Medicaid Coordination Office to identify "existing rules that may be outmoded, ineffective, insufficient, or excessively burdensome, and to modify, streamline, expand, or repeal them." As a first step the office is addressing conflicting requirements between Medicaid and Medicare that could create barriers to high quality, seamless, and cost-effective care for dual eligibles. For example, Medicaid and Medicare have different coverage standards for accessing durable medical equipment.

The office is seeking input in six areas: care coordination, fee-for-service benefits, prescription drugs, cost sharing, enrollment and appeals.


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1 comments on "HHS Seeks Comments on Dual-Eligibles"


Judy Halcom (5/16/2011 at 5:59 PM)
My sister in law is a dual eligible. Under Medicare, she does not qualify for having her Part B premium paid because of husbands income. However, on Medicaid, when she had to be in nursing home, she did qualify. However, when she was discharged from nursing home, Medical Assistance was to notify social security that she no longer qualified for the state paying the part b premium(As of April 1, 2010). However, the state did not notify Medicare and Social Security. When They finally did notify them, social security sent a notice to my sister in law that because she did not pay premiums in 2010 she now had to pay a higher premium in 2011. Mind you, my sister in law was never notified by Medicaid that the state would no longer pay her premiums and the state never notified ss and medicare. so my sister in law has to pay $20.00 more a month for part b premiums. There is something radically wrong is this scenario. I have tried to contact Medicaid and just get the run around. All they should have to do is notify social security that Medicaid made a mistake and the patient should still only have to pay $96.40 instead of $115.40.