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Senate plan would coordinate dual-eligible care

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Mar 14, 2024
Senators give a press conference on their dual-eligibles bill (Photo credit: Senate Photographers Association).

Carper at a press conference on dual eligibles. Photo: U.S. Senate photographer

A bipartisan group of senators on Thursday outlined a plan for integrating Medicare and Medicaid services for the millions of people who are eligible for both programs.

Why it matters: The programs aren't linked, and so-called dual eligibles often have trouble navigating between them to obtain care, long-term services and medical equipment.

What's inside: The DUALS Act of 2024 would require states and CMS to develop and implement a single integrated health plan for all dual-eligible beneficiaries.

  • It would designate a care coordinator for each beneficiary to help assess plan offerings, as well as try to reduce third-party marketing of multiple plans targeted at beneficiaries.
  • The legislation is sponsored by Sens. Bill Cassidy, Tom Carper, John Cornyn, Mark Warner, Tim Scott and Bob Menendez. The group has been working on the bill for several years.

By the numbers: 12.2 million Americans are jointly enrolled in Medicare and Medicaid. Often these are low-income patients with complex medical needs.

  • Despite making up a small percentage of total federal health program enrollees, dual eligibles account for a disproportionate share of spending.
  • 19% of Medicare enrollees are also eligible for Medicaid but account for 34% of program spending. Thirteen percent of Medicaid enrollees also are eligible for Medicare and account for 30% of overall spending.
  • Dual eligibles could generate billions of dollars for health insurers that manage benefits, because the cohort is expected to grow and generates higher levels of reimbursement.
  • Lawmakers argued that their legislation would help reduce federal spending on dual eligibles, while also improving health outcomes.

What's next: Cassidy said the group has discussed the bill with leaders of the Senate Finance Committee and "thinks they will be interested" in further steps.

  • Carper said he planned to seek out Rep. Lisa Blunt Rochester, a member of the House Energy and Commerce Committee, Thursday about taking up the cause on the House side.
  • Carper is retiring at the end of this session, and dual eligibles could be a legacy issue.
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