In all of the discussion and debate about the Affordable Care Act, very little attention has been paid to how the health reform law affects people who are dually eligible for both Medicare and Medicaid. However, the law has a number of provisions designed to improve the delivery of care to the roughly nine million mostly elderly and lower income people who are covered by both.
One important provision of the Affordable Care Act creates a new “Office of Duals” at the Centers for Medicare and Medicaid Services. Officially named the Medicare-Medicaid Coordination Office (MMCO), the Office is working closely with states to develop new models for delivering care to duals. Many of these new models seek to integrate Medicare and Medicaid funds into a single entity responsible for delivering the services covered under both programs.
These new models bring both great promise and risk. Implemented with the beneficiary in mind, they promise to improve care, decrease unnecessary institutionalization and slow the cost curve in the health system. But, implemented with cost savings and administrative efficiencies as their primary goals, they risk creating new barriers to care and new financial incentives for limiting the care provided to the most high need individuals in the health system.
National Senior Citizens Law Center staff, in concert with others from national advocacy organizations, meet regularly with the MMCO to discuss these new integration efforts and other initiatives the Office has undertaken. At the same time, we are working with state-based advocates to help evaluate state-specific plans for integration. With support from The SCAN Foundation, we will soon be producing a series of papers providing recommendations on improving the delivery of care to duals in current and new systems.