Consumers Count: States Should Listen to Dual Eligibles in Designing New Models of Care
Nathanson, Paul, Richtman, Max, Aging Today
The National Senior Citizens Law Center (NSCLC) and the National Committee to Preserve Social Security and Medicare (NCPSSM) are committed to ensuring that the states' dual eligible proposals contain adequate consumer protections for dual eligibles. The NSCLC, in particular, is engaging advocates nationwide to make sure consumers' concerns are heard and addressed.
As part of the Patient Protection and Affordable Care Act (ACA), states are developing proposals to create new care models, including using Medicaid managed care programs, for many of the 9 million people who qualify for both Medicare and Medicaid. These so-called dual eligibles have legitimate concerns about the future of their healthcare, and are worried their issues will be overlooked in the rush to find a new way to deliver care and slow the cost curve in America's healthcare system.
According to an April 2012 Kaiser Family Foundation issue brief, Medicare's Role for Dual Eligible Beneficiaries (www. kff.org/medicare/upload/8138-02.pdf), dual eligibles account for a disproportionate share of Medicare and Medicaid spending. Dual eligibles comprised 20 percent of the Medicare population, but 31 percent of Medicare spending, and 15 percent of the Medicaid population, but 39 percent of Medicaid spending. They are also more likely to be in fair to poor health, have cognitive, mental or functional impairments, or live in institutions.
The states, together with the Centers for Medicare & Medicaid Services (CMS), have committed to designing personcentered models. We believe that while these models have promise, they also contain great risk. If reforms are implemented with the singular or primary goals of cost savings and administrative efficiencies, they will fail the very people they are designed to help. All states participating in the demonstrations have set up stakeholder processes that are supposed to incorporate consumer input, but flaws in the process have frustrated dual eligibles and their advocates.
If models are to be person-centered, then policymakers must listen to and address valid fears and concerns expressed by people like Rhön Koch and Julie Peck, whose lives will be directly impacted by these potentially sweeping changes.
Listen to the Consumer Base
Koch lives in Michigan and is dually eligible and disabled. Michigan proposes a two-contract approach, with one contract covering all physical health services and long-term supports and services and another covering all behavioral health and developmental disability inpatient and outpatient supports and services. However, Koch says the state's process for gathering input on its proposal left much to be desired. Many Michiganders with disabilities knew nothing about the public stakeholder events, and incredibly, the events often weren't accessible to wheelchairs or by public transportation. Koch also reports that her comments proposing voluntary opt-in enrollment and other consumer protections- many based on NSCLC suggestions- haven't been incorporated in the state's proposal.
Peck is a grandmother, adoptive mother and guardian of a medically complex young man who is dually eligible. Her state, Massachusetts, has already submitted its proposal to CMS; it plans to combine Medicare and Medicaid funding streams to provide integrated care through a managed care organization for dual eligibles younger than 65. …