Report: Dual-eligible programs costlier, more challenging than expected

States surprised by the cost of adapting their technology systems

States say it's costlier and more challenging than expected to coordinate care for individuals who are dually eligible for Medicare and Medicaid, according to a CMS-commissioned report released last week, Modern Healthcare reports.

Although dual-eligible beneficiaries make up only about 13% of the Medicare and Medicaid population, they tend to be especially expensive to cover, accounting for 27% of Medicare spending and 40% of Medicaid spending.

To rein in these costs and better coordinate care, CMS worked with 12 states to implement dual-eligible demonstration programs through the Affordable Care Act.

Report details, findings

For the report, RTI International researchers examined dual-eligible demonstration programs in seven states in operation as of May 1, 2014.

How hospitals are finding—and treating—high-risk patients

The researchers found that the states:

  • Faced conflicting Medicare and Medicaid policies concerning eligibility criteria and enrollment;
  • Had to manage a large influx of enrollees at one time;
  • Had staff "spen[d] an inordinate amount of time trying to locate enrollees in order to complete initial health assessments and introduce enrollees to the benefits of the demonstration;" and
  • Were surprised by the cost of adapting their technology systems to implement the demonstration programs.

Overall, the researchers reported that "addressing the nuts and bolts of aligning the Medicare and Medicaid program policies, procedures, and systems has been more time-consuming than [states] expected."

They added, "It is unclear at this point whether the time and resource commitments will diminish ... or if these efforts are inherent to coordinating Medicare, a national standardized program, with Medicaid, a State-specific program with unique features."

According to Modern Healthcare, CMS has contracted RTI to conduct additional research on the demonstrations. The resulting reports will be published on CMS's website (Dickson, Modern Healthcare, 1/25; American Health Line, 1/22; RTI International report, accessed 1/27).

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