• It’s the duals, stupid

    J. Lester Feder has a terrific piece in Politico today on dual (Medicare-Medicaid) eligibles.

    As governors have been sounding the alarm about a collective $175 billion shortfall in state Medicaid budgets in the coming fiscal year, the Obama administration is looking to reduce the gap by improving the treatment of just 2.9 million of Medicaid’s 58 million enrollees.

    How could the treatment of just 5 percent of beneficiaries make a dent in such a huge funding gap?

    Because, President Barack Obama told the National Governors Association in February, “we know that over half of all Medicaid costs come from just 5 percent of enrollees.”

    Many of these patients are known as “dual eligibles,” poor elderly or disabled individuals who qualify for Medicare as well as Medicaid. […]

    This fractured financing is obviously a tragedy for the beneficiary’s health. Gaps in care can result in an individual who could have had many more years at home being confined to an institution for life. But it also is a disaster for the health care financing system. Public programs are paying for an extra hospitalization plus nursing home care that could have been avoided through better care after the initial discharge.

    Patricia Nemore of the Medicare Advocacy Center also cautions that, although there are savings to be found, the underlying reason for dual eligibles’ high use of health care services will not go away.

    “We can do better, and we might save money is a reasonable way to proceed,” she said, “but one reason they cost a lot of money is that they’re sick.”

    It’s good to be reminded of who Medicaid serves and where most of the money is going. Children, parents of children, disabled individuals, and the elderly are, principally, who the program serves. The dual eligibles — very sick individuals who qualify for Medicaid and Medicare — are consuming a great deal of the funding, well beyond their proportion of the total population served by either program.

    Are those who characterize Medicaid as an arm of the welfare state that promotes “family breakdown and social disrepair” thinking about the dual eligibles?

     

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    • “This fractured financing is obviously a tragedy for the beneficiary’s health. Gaps in care can result in an individual who could have had many more years at home being confined to an institution for life. But it also is a disaster for the health care financing system. Public programs are paying for an extra hospitalization plus nursing home care that could have been avoided through better care after the initial discharge.”

      That sounds to me like the program is failing these people.

    • a person has to have significant medical, mental, and financial problems to be eligible for both medicare and medicaid

      i don’t when governors and presidential administrations started using dual eligibles as scape goats but it is shameless

      there is no one to speak for these people

      an acquaintance who is supported through Social Security Disability and is dual eligible because of income level – lost medicaid coverage and as a result had to pay medicare co-pays for all of his many doctor visits – a serious reduction in his income

      he also lost dental and vision coverage

    • I don’t understand how dual eligibles are a drain on state Medicaid budgets. Once they have Medicare as their primary insurance, Medicaid goes from paying 100% of their bills to just 20%. In Arizona, where I live, I have met a number of dual eligibles who never signed up for Medicare Part B because nobody told them to do so. The state of Arizona should be on top of this so they can move the cost of these individuals to Medicare,

      In Arizona, all Medicaid enrollees are put into an HMO. If they are on Medicare, I wonder if the state starts paying the HMO less money because the plan is then covering only 20% of the cost of medical care for that person.