A new law has been proposed by a bipartisan group of U.S. senators that could bring significant changes for dual enrollees of Medicare and Medicaid. The aim of this proposed legislation is to integrate the two plans into a more seamless program, offering a more streamlined experience for beneficiaries.
A group of lawmakers, including Republicans Bill Cassidy of Louisiana, John Cornyn of Texas, and Tim Scott of South Carolina, along with Democrats Tom Carper of Delaware, Mark Warner of Virginia, and Bob Menendez of New Jersey, have introduced the Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024. Their aim is to enhance Medicare and Medicaid for individuals who are eligible for both programs, also known as dual eligibles.
According to Cassidy, patients who are eligible for both Medicare and Medicaid tend to have poorer outcomes compared to other groups, despite the higher expenditure on their healthcare. He suggests that improving the collaboration between Medicare and Medicaid not only leads to better patient health but also helps save money for taxpayers.
According to Carper, the bill aims to address the complexity surrounding the healthcare programs for beneficiaries who are dually eligible for Medicare and Medicaid. These individuals are often among the sickest and most vulnerable patients.
“We have put in a lot of effort for the past three years to draft this legislation, and I am thrilled to present the outcome of our dedicated work today,” expressed Carper.
According to Cornyn, the coordination of care between Medicare and Medicaid is often lacking, resulting in negative outcomes for patients and wasteful spending within the healthcare system.
According to Cornyn, this legislation would assist in streamlining the system, enhancing the experience of beneficiaries, and promoting responsible spending of taxpayer dollars by mandating states to formulate an integrated health plan for these individuals.
If the DUALS Act is approved, every state would be obligated to create a comprehensive and integrated health plan for individuals who are eligible for both Medicare and Medicaid. This plan could either be a completely new system or an enhancement to the current coverage options available.
Scott emphasized the need for improved coordination and integration of Medicare and Medicaid services in order to provide better care for dually eligible individuals. He stated, “Many states currently have fragmented care and confusing bureaucracy, which is not acceptable for this vulnerable population. It is our responsibility to do better.” Scott’s proposed bill aims to address these issues and ensure that patients across the nation have access to the high-quality care they deserve.
The bill aims to decrease the confusion surrounding lookalike plans that target dual-eligible recipients but do not provide any coordination. Additionally, it proposes implementing a unified appeal process instead of having separate options for Medicare and Medicaid.
Approximately 12.2 million individuals who are enrolled in both Medicare and Medicaid, primarily consisting of low-income or disabled Americans, may be affected by these proposed changes. Although this group represents a relatively small portion of overall enrollees, their healthcare expenses constitute a significant percentage of total spending.
Dual eligibles, who constitute just 19 percent of Medicare enrollees, account for a significant 34 percent of the program’s spending. Similarly, in Medicaid, although they represent only 14 percent of all enrollees, dual eligibles contribute to 30 percent of the overall spending.
According to Chris Fong, co-CEO and Medicare insurance specialist at Smile Insurance Group, the proposed bill has the potential to provide dual enrollees with a more streamlined coverage option. This would be especially beneficial for those who have faced difficulties navigating the complexities of Medicare in the past.
Fong, however, raises doubts about the variety of options that would be accessible to individuals with dual eligibility if the bill were to be enacted.
“We view this bill as having both positive and negative aspects,” Fong explained to Newsweek. “On the positive side, it has the potential to enhance coordination of benefits and streamline the process for beneficiaries. However, it may also restrict the range of Medicare Dual Special Needs plans accessible to this specific group of beneficiaries.”
Insurance companies that offer dual lookalike plans may strongly oppose this process, leading to significant pushback. According to Fong, lobby groups representing these companies are expected to take action to prevent the implementation of such changes.
According to Fong, dual lookalike plans are typically offered by insurance companies that are unable to offer a DSNP plan due to the lack of a Medicaid contract in specific areas or states.
Enrolling in a genuine DSNP plan is something I always recommend to beneficiaries. The level of care coordination is significantly higher, especially when the Medicaid plan provider aligns with the Medicare DSNP plan.
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