Health Reform and Benefit Mandates

Presenter Information

Erica Barnum, Providence College

Location

Harkins 301

Event Website

http://www.providence.edu/hpm/Pages/Conference.aspx

Start Date

23-3-2013 9:30 AM

End Date

23-3-2013 10:45 AM

Description

My paper discusses the topic of dual eligible beneficiaries – a group of some nine million individuals that has rightly earned a reputation for being the most costly, frail, sickly, and vulnerable population. Individuals are considered “dual eligible” when they qualify for the benefits of both government programs of Medicare and Medicaid. The main problem within the dual eligible arena is the lack of coordination between these two programs – the federal government wholly funds Medicare but Medicaid is a joint federal-state program that varies from state to state. Because these programs were not designed to work together and sometimes even work at cross-purposes, dual eligible beneficiaries have incurred excessive costs for both the federal and state governments. More importantly, conflicts between the policies of Medicare and Medicaid have led to rather poor quality of care for these needy individuals. Thus far, there have been strides forward in better integrating and coordinating care for dual eligible seen in the Program of the All-Inclusive Care for the Elderly (PACE) and Dual-eligible Special Needs Plans (D-SNPs). The ACA also plans to continue forward in attempts to reduce costs and improve care for dual eligibles. However, evidence from these past, current, and future efforts, indicates significant reform will not be possible until the government implements a mandate for state participation in integrated programs for dual eligible beneficiaries. Without this bold yet necessary move, costs will continue to skyrocket at an unsustainable rate and, worse, these individuals will not see an improvement in the quality of care they receive.

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Mar 23rd, 9:30 AM Mar 23rd, 10:45 AM

The Danger of Duality: Medicare and Medicaid as a Double Threat

Harkins 301

My paper discusses the topic of dual eligible beneficiaries – a group of some nine million individuals that has rightly earned a reputation for being the most costly, frail, sickly, and vulnerable population. Individuals are considered “dual eligible” when they qualify for the benefits of both government programs of Medicare and Medicaid. The main problem within the dual eligible arena is the lack of coordination between these two programs – the federal government wholly funds Medicare but Medicaid is a joint federal-state program that varies from state to state. Because these programs were not designed to work together and sometimes even work at cross-purposes, dual eligible beneficiaries have incurred excessive costs for both the federal and state governments. More importantly, conflicts between the policies of Medicare and Medicaid have led to rather poor quality of care for these needy individuals. Thus far, there have been strides forward in better integrating and coordinating care for dual eligible seen in the Program of the All-Inclusive Care for the Elderly (PACE) and Dual-eligible Special Needs Plans (D-SNPs). The ACA also plans to continue forward in attempts to reduce costs and improve care for dual eligibles. However, evidence from these past, current, and future efforts, indicates significant reform will not be possible until the government implements a mandate for state participation in integrated programs for dual eligible beneficiaries. Without this bold yet necessary move, costs will continue to skyrocket at an unsustainable rate and, worse, these individuals will not see an improvement in the quality of care they receive.

http://digitalcommons.providence.edu/auchs/2013/panela2/3