Home > Past Briefings > Briefing Detail Page
 

Briefing Detail Page

Change Text Size:   Smaller Text Size   Larger Text Size   Default Text Size    

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.

Speakers

 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.

Speaker Presentations

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.)

Source Materials

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

 


Sister Carol Keehan on Health Law Enrollment Challenges this Year


Video 3:00

A new Alliance for Health Reform video features Sister Carol Keehan of the Catholic Health Association of the United States addressing the challenges of quickly enrolling millions of Americans for health insurance this fall. Open season begins October 1 of this year, yet she says that up to 85 percent of those who will be newly eligible for Medicaid or for subsidies to buy private insurance in state-based exchanges don't know it.  FULL TRANSCRIPT

Read More 


Jonathan Blum on CMS Efforts to Keep Medicare Spending Growth Down


Video (2:54)

Jonathan Blum, acting principal deputy administrator and director of the Center for Medicare at the Centers for Medicare and Medicaid Services (CMS), addresses the slower growth of Medicare spending over the last few years, and what his agency is doing to try and continue the trend. “There are promising signs that this strategy to change the payment system, to change the payment models, to focus on waste and abuse, is paying off," he said. "We are taking a whole new approach to addressing fraud in the program. Much more data resources, much more on the ground reaction. We have seen dramatic spending declines in areas of spending, such as home health and durable medical supplies that historically fueled lots of the fraud.”  FULL TRANSCRIPT

Read More 

Updated Toolkit -- The Sustainable Growth Rate: Seeking a ‘Doc Fix’ at the Edge of a Fiscal Cliff


A new Alliance toolkit tells you what you need to know about the current policy debate about the $138 billion Medicare physician payment problem – the "doc fix." The public is keeping a close eye on federal budget deficit reduction efforts this year, including potential automatic spending cuts initially mandated by the Budget Control Act of 2011. Yet one component of the debate has been largely ignored - the Sustainable Growth Rate (SGR). Indeed, because of the SGR, physicians in January 2013 faced a 26.5 percent cut in Medicare reimbursement rates. Last-minute congressional intervention delayed the cut until January 2014 as part of the American Taxpayer Relief Act of 2012. Without intervention, physicians will receive a 25 percent reimbursement cut in January 2014. At the same time, according to the most recent Congressional Budget Office (CBO) estimates, if Congress and the president agree to permanently eliminate the SGR, the deficit will grow by another $ 138 billion over 10 years. The cost of repealing the SGR has fallen significantly since last year, spiking a new interest in permanently fixing the problem.

To download, click here.


Read More 

Illinios Health Law Implementation: Race to the Starting Line


Health care experts recently kicked off a series of briefings for reporters addressing complex issues that states face leading up to major 2014 health law changes. Illinois will have a federal partnership insurance exchange next year, but may take more control after that, Deputy Gov. Cristal Thomas said at the first briefing in Chicago. Georgetown University insurance expert Sabrina Corlette, hospital leader David DiLoreto and journalist Bruce Japsen also spoke at the briefing, held Dec. 12 at Columbia College, and sponsored by the Association of Health Care Journalists, the Alliance for Health Reform and the Robert Wood Johnson Foundation.

Read More


Douglas Holtz-Eakin: Health Care Spending Lull Only Temporary


Video (3:11)

A new Alliance for Health Reform video features Douglas Holtz-Eakin of the American Action Forum, and a former director of the Congressional Budget Office, arguing that recent slower spending growth in health care won’t continue.

"We also saw a slowdown in the mid-90s, and we all declared victory and it came right back. I think next year we’ll see a noticeable uptick. There will be lots of new people entering the insurance markets because of the exchanges and the subsidies that come along with them, and those subsidies are very generous. … These are an invitation for people to get coverage and to buy more health care. I think that’ll place a lot of pressure on spending."

FULL TRANSCRIPT

Read More 


Uwe Reinhardt Questions Bundled Payment Savings Prospects


Video (2:58)

A new Alliance for Health Reform video features Princeton’s Uwe Reinhardt questioning whether bundling payments for medical services might actually lead to higher – not lower – costs.

"The ACO's, the accountable care organizations, could create local monopolies that could dictate to you what that bundled price would be, and some of us fear that bundled prices might be even more than what the fee-for-service for that bundle would be today. … You really should align all the payers and say, 'Let us jointly negotiate with the ACOs what those bundles should be so that they cannot divide and rule and sort of make us on the buy side weak.'"

FULL TRANSCRIPT

Read More 

Copyright 1997-2013 Alliance for Health Reform
1444 Eye Street, NW, Suite 910 Washington, DC 20005-6573      202-789-2300      202-789-2233 fax      info@allhealth.org      Sitemap