Senators eye dual-eligible changes: 5 things to know

A bipartisan group of senators is introducing legislation to require states to offer integrated Medicaid and Medicare plans to dual-eligible beneficiaries. 

Led by Louisiana Sen. Bill Cassidy, MD, the "Delivering Unified Access to Lifesaving Services Act of 2024" would require states to offer at least one comprehensive integrated Medicare-Medicaid plan. 

Around 12.2 million people are eligible for both Medicare and Medicaid coverage based on their age, income and disability status. Dual-eligible beneficiaries are often enrolled in two seperate Medicare and Medicaid plans, which can make it difficult to coordinate care. 

Here are five things to know about the legislation: 

  1. Twelve states have participated in a pilot program to test integrated Medicaid and Medicare plans. The results have not shown consistent improvement in outcomes, NPR reported March 14. 
  2. The legislation would crack-down on "look-alike" D-SNP plans — Medicare Advantage plans marketed to dual-eligible individuals that do not coordinate benefits. 
  3. The proposed bill would also require all states to allow Program of All-Inclusive Care for the Elderly plans and lower the eligibility age for the model to 55. 
  4. The Alliance for Community Health Plans, PACE organizations and several other providers endorsed the legislation. 
  5. Dr. Cassidy told NPR the legislation has slim odds of passing this session but said he believes Congress will eventually be compelled to act on the issue. 

Read more here. 

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