Nine million reasons for reform: Mending the Medicare-Medicaid misalignment

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Event Summary
At an AEI event on Tuesday morning, health policy experts joined Joseph Antos to discuss how to improve care for dual eligibles, defined as people enrolled in Medicare due to age or disability status and Medicaid due to low incomes.

Melanie Bella of the Medicare-Medicaid Coordination Office began the discussion with a report of the Centers for Medicare and Medicaid Services' (CMS) efforts to coordinate care for the dually eligible population, most notably the Financial Alignment Initiative. The initiative — currently underway in 27 states — moves dual eligibles into state-run plans supported by federal funds. Judith Feder of Georgetown University’s Public Policy Institute went on to question CMS’s decision to cede responsibility of dual eligibles to the states, given that the federal government currently spends about four times more on these individuals  than the states do.

Alan Weil of the National Academy for State Health Policy framed this issue as a culture clash between the two programs: while Medicare strives to preserve choice for its beneficiaries, Medicaid often limits choice in an attempt to contain costs. Tim Schwab of SCAN Health Plan demonstrated that when designed appropriately, special needs plans for dual eligibles can play a large role in improving integration between Medicare and Medicaid.
-- Catherine Griffin

Event Description
Nine million low-income seniors and people with disabilities are enrolled in both Medicare and Medicaid. While many of these dually eligible individuals have multiple chronic conditions and are seeing multiple health providers, only one in ten is enrolled in managed care. As a result, these beneficiaries find themselves caught between unaligned rules and incentives across the two programs, resulting in uneven care and increased costs. 

The new Financial Alignment Initiative from the Centers for Medicare and Medicaid Services (CMS) intends to improve the quality of care and reduce costs by merging program funding and allowing states to integrate all services through newly created health plans. Although better care coordination has long been a goal, experts disagree about how improved care can best be achieved, with some arguing that Medicare is abdicating responsibility for its sickest and poorest beneficiaries. The Financial Alignment Initiative has set ambitious time frames for making sweeping changes in the care offered to dual eligibles.  Will dual eligibles be able to obtain the services they need once they are shifted into these new health plans? Will savings come at the expense of patient care, or will this approach lead to real efficiencies in delivering care? How will CMS know if they’ve gotten it right?

A panel of experts will discuss the potential of this demonstration to promote unprecedented coordination between the federal Medicare program and the state-run Medicaid program. Melanie Bella, director of the Medicare-Medicaid Coordination Office at CMS, will lead off the discussion. She will be joined by a panel of individuals that reflects the diversity of opinion concerning the care of the dually eligible population.

Full video will be posted in 24 hours.

If you are unable to attend, we welcome you to watch the event live on this page. Full video will be posted in 24 hours.

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