Medicare and Medicaid Coordination: Special Case of the Dual Eligible Beneficiary

Abstract

The Affordable Care Act of 2010 (ACA) includes provisions related to the cost and quality of the care received by dually eligible Medicare and Medicaid beneficiaries. More than nine million Medicare beneficiaries are also enrolled in the Medicaid program. Sixty percent are age 65 years and older. Many dual-eligible patients and their caregivers experience difficulties navigating the health care system. The division of responsibility and funding across the Medicare and Medicaid programs only intensifies these problems. Prior to the passage of the ACA, special needs plans, authorized in 2003, focused on specific subtypes of dual eligible beneficiaries with the intent to integrate the financing and delivery of care for the full range of health care needs. The Program of All-Inclusive Care for the Elderly stands out as a successful example of a seamlessly integrated program that brings together Medicare and Medicaid benefits into one delivery system. The ACA established the Federal Coordinated Health Care Office (FCHCO). In 2011, the FCHCO began the Medicare-Medicaid Financial Alignment Demonstration. The program allows state Medicaid offices to develop innovative approaches to improve the coordination of care for the dual eligible population, while adding efficiencies and incentives that will reduce the cost of care. At the start of 2014, eight States had completed signed agreements with CMS to initiate demonstrations. Geriatrics providers’ clinical leadership, when combined with consumer advocacy efforts, is essential to ensure that the financial incentives in the integrated care demonstrations are aligned to ensure optimal care for vulnerable older adults.