Washington, DC -  Today the Bipartisan Policy Center releases two white papers and calls for comments on policy options that address how federal and state policymakers can better integrate and streamline care for the 12.1 million Americans who are eligible for both Medicare and Medicaid. These individuals, known as “dual-eligibles,” are typically older, poorer, and sicker than the general population with multiple chronic conditions such as diabetes, and lung and heart disease. However, according to the Centers for Medicare and Medicaid Services (CMS), fewer than 10% are enrolled in integrated systems of care, which can improve patient outcomes, enhance patient experience, and reduce hospitalizations. 

Because of age and chronic conditions, this population is now at greater risk of contracting the coronavirus (COVID-19) so the need to improve their quality of care is more urgent. Even before the threat of COVID-19, dual-eligible individuals were at a disadvantage in navigating two separate programs with different benefits and eligibility requirements.  

In recent years, Congress, CMS, health care providers, plans, and states have made progress in the integration of these programs, as a path to improved coordination of clinical and behavioral health services, long-term services and supports, and social services. Yet BPC’s papers point out more must be done to integrate care.  

“Significant barriers to integration continue to exist,” said Katherine Hayes, director of BPC health policy. “For most individuals navigating two separate programs would be daunting, but for dual-eligible individuals and their family, it can be overwhelming, especially as they manage chronic medical conditions and other cognitive or physical limitations.” 

BPC’s policy options include both short- and long-term proposals that eliminate regulatory barriers to aligning the two programs and provide financial incentives and assistance to states to encourage the transition to full integration. These policy options are designed to improve the enrollee experience and better educate these beneficiaries about their care options. One key option under consideration would require states to fully integrate Medicare and Medicare services within five years. A federal fallback program is proposed for those states that choose not to integrate programs. 

While the evidence is still outstanding on the potential for the long-term savings, better care coordination of services for these low-income, high-needs patients has reduced hospitalizations and readmissions, and led to an expansion of home and community-based services that extend the time patients are able to remain in the comfort of their own homes. 

“We hope to get stakeholder input on these policy options,” Hayes added. “It is critical that we streamline services for this population, so these two programs are more user-friendly and accountable. Without changes in federal policy, the ability or willingness of more states to make this transition is very limited.”  

BPC is also seeking input on short-term solutions to allow dual-eligible individuals to remain safely in their homes. “COVID-19 is showing us how important it is to protect this vulnerable population,” Hayes added. “They need to be flexible and create innovative ways to offer quality patient-centered care to those with complex needs has never been greater than today. The use of telehealth and community-based services are proving vital to keeping this population out of hospitals, nursing homes, and rehabilitation centers, especially with these facilities experiencing high rates of the coronavirus.” 

BPC requests all comments and feedback on these recommendations be submitted through this online form by June 1st. A final report with be issued in July of 2020.  

Part 1: Integrating Care for Beneficiaries Eligible for Medicare and Medicaid: An Update 

Part 2: Policy Options for Integrating Care for Individuals with Both Medicare and Medicaid