Briefing Detail Page
Caring for People Covered by Both Medicare and Medicaid: A Primer on Dually Eligible Beneficiaries
Friday, June 03, 2011
This was an introductory session designed to inform the staff of new members of Congress both in Washington and in district or state offices about the people who receive benefits from both the Medicaid and Medicare programs (often called “dual eligibles”). The briefing was designed to be helpful to staff members unfamiliar with this important issue.
The nine million dually eligible beneficiaries are generally poorer and sicker than other Medicare beneficiaries, tend to use more health care services, and thus account for a disproportionate share of Medicare and Medicaid spending. Because they often have complex medical and long-term care needs and must navigate both Medicaid and Medicare benefits and financing, they present a special challenge for those seeking a more efficient and coordinated care delivery system. In this context, a good understanding of the needs and issues confronting care for dual eligibles will be essential to congressional health staff.
A distinguished panel addressed such basic questions as: Who is dually eligible for Medicare and Medicaid? What are the characteristics and needs of this population? How do Medicaid and Medicare coordinate payment and care for this population? What federal and state barriers complicate these efforts? What is being done to address these challenges? What provisions in health reform address improving the coordination and delivery of services for dual eligibles?
Panelists included: Melanie Bella, director of the new Federal Coordinated Health Care Office (“Office of Duals”) at CMS; Shawn Bloom, National PACE Association; Scott Leitz, Minnesota Department of Human Services; and Jack Meyer, Health Management Associates. Barbara Lyons of KCMU and Kevin Arts of the Alliance co-moderated.
Barbara Lyons , Kaiser Family Foundation's Kaiser Commission on Medicaid and the Uninsured, Moderator
Kevin Arts, Alliance for Health Reform, Moderator
Melanie Bella, Federal Coordinated Health Care Office, Speaker
Scott Leitz, Minnesota Department of Human Services, Speaker
Shawn Bloom, National PACE Association, Speaker
Jack Meyer, Health Management Associates, Speaker
(Click on the camera icon to see a video of the speaker's presentation.)
|Transcript, Event Summary and/or Webcast and Podcast|
Transcript: Transcript (Adobe Acrobat PDF), 6/3/2011
Event Summary: Event Summary (Adobe Acrobat PDF), 6/3/2011
Full Webcast/Podcast: Caring for People Covered by Both Medicare and Medicaid: A Primer on Dually Eligible Beneficiaries
|The full webcast and podcast for this briefing, as well as videos of individual speakers' presentations, are provided by Kaiser Family Foundation.
Barbara Lyons Presentation (PowerPoint), 6/3/2011
Melanie Bella Presentation (PowerPoint), 6/3/2011
Scott Leitz Presentation (PowerPoint), 6/3/2011
Shawn Bloom Presentation (PowerPoint), 6/3/2011
Jack Meyer Presentation (PowerPoint), 6/3/2011
(If you want to download one or more slides from these presentations, contact us at info@allhealth or click here for instructions.)
Speaker Biographies (Adobe Acrobat PDF), , 6/3/2011
Agenda (Adobe Acrobat PDF), , 6/3/2011
Material's List (Adobe Acrobat PDF), , 6/3/2011
Experts Sourcelist (Adobe Acrobat PDF), , 6/3/2011
Event Summary (Adobe Acrobat PDF), , 6/3/2011
|Offsite Materials (briefing documents saved on other websites)|
Innovation Profile: The ‘GRACE’ Model: In-Home Assessments Lead to Better Care for Dual Eligibles., Health Affairs, 3/1/2011
- Bielaszka-DuVernay, Christina.
Comprehensive Primary Care for Older Patients with Multiple Chronic Conditions, JAMA, 11/1/2010
- Boult, C. and Wieland, G.D.
People Enrolled in Medicare and Medicaid, Centers for Medicare and Medicaid Services, 5/11/2011
Quick Facts about Programs of All-Inclusive Care for the Elderly (PACE), Centers for Medicare and Medicaid Services., 1/1/2008
HHS Offers Cash to States For Medicaid, National Journal, 4/14/2011
- DoBias, Matthew
Dual Eligibles With Mental Disorders And Medicare Part D: How Are They Faring?, Health Affairs, 5/25/2011
- Donohue, J., et al.
Federal Register Notice For Public Comment by CMS for Aligning Medicare and Medicaid, Federal Register, 6/16/2011
Developing an Integrated Care Program for Dual Eligibles Using Special Needs Plans, Center for Health Care Strategies, 1/1/2011
- Gore, S. and Lind, A.
The Role of Medicare for the People Dually Eligible for Medicare and Medicaid, The Kaiser Family Foundation, 1/1/2011
- Jacobson, G., et al.
Dual Eligibles in the Affordable Care Act, Kaiser Family Foundation, 6/1/2011
Dual Eligibles: Medicaid’s Role for Low-Income Medicare Beneficiaries, Kaiser Family Foundation, 6/1/2011
When Care Is Split Between Medicare And Medicaid: KHN Interview With Melanie Bella, Kaiser Health News, 2/24/2011
- Kenen, Joanne
From the Beneficiary Perspective: Core Elements to Guide Integrated Care for Dual Eligibles, Center for Health Care Strategies, 12/1/2010
- Lind, A. and Gore, S.
Report to the Congress: Aligning Incentives in Medicare: Coordinating the Care of Dual-eligible Beneficiaries, The Medicare Payment Advisory Commission, 6/1/2010
Program of All-inclusive Care for the Elderly (PACE): Key Features, National PACE Association, 6/2/2011
Key Research Findings: Quality Care, Improved Health, Cost Effective, National PACE Association., 6/3/2011
Minnesota Department of Human Services: National Council on Disability Quarterly Meeting, , 7/21/2009
- Parker, Pamela
Federal agency seeks Medicaid savings with better care, Reuters, 5/11/2011
Minnesota's Senior Health Options Integrates Long-Term and Acute Care, Robert Wood Johnson Foundation., 1/1/2009
Dual Eligibles: Medicaid Enrollment and Spending for Medicare Beneficiaries in 2007, Kaiser Family Foundation’s Commission on Medicaid and the Uninsured., 1/1/2007
- Rousseau, D., et al.
DataBrief Series: No. 1, 2, 3, 10, 11 and 12., The SCAN Foundation., 9/23/2010
Toolkit on Connection Between Health and Housing
A new Alliance toolkit, “The Connection between Health and Housing: The Evidence and Policy Landscape,” provides a detailed look into federal, state and local initiatives, as well as cost implications for health and housing programs.
Attempts to tie health and housing policy are gaining momentum, amid evidence that housing, a social determinant of health, is an important factor in the health status of various populations. More than 610,000 people experience homelessness in the U.S., and over 250,000 individuals within that population have a severe mental illness or a chronic substance use disorder, according to the Department of Housing and Urban Development.
Toolkit on Biosimilars
The Alliance for Health Reform has released a new toolkit, “Biosimilars: Unpacking Complex Issues.”
The Affordable Care Act created an expedited licensure pathway for biosimilars, and, in March 2015, the U.S. approved the first biosimilar, leaving policy makers, regulators, providers and stakeholders to grapple with regulatory and financial questions.
Biosimilars are similar – but not identical – to biologic drugs, and cost less. Unlike traditional pharmaceuticals, biologic drugs are derived from living organisms and tissues, making them more complex and expensive to produce.