Many New Yorkers are known as “dual eligibles.” This refers to residents who qualify for both the New York Medicaid and Medicare programs. The majority are individuals who are over 65 years old with some sort of chronic medical issues. Residents seeking out long-term care, like a nursing home stay, are frequently dual eligibles.
There has long been mass confusion about the most efficient way to provide care for these individuals; working through both systems can be an administrative nightmare. Medicaid and Medicare serve different populations, have different requirements, and operate in different ways. As a result, individuals seeking support from both often “fall through the cracks,” receiving less than they are entitled.
To tackle the problem, a few states are joining in on a Center for Medicare and Medicaid Services (CMS) pilot project to coordinate coverage for dual-eligibles. As reported this week by Modern Health, New York is joining that list of states, becoming one of six to participate in the “Financial Alignment Initiative.” The project was called for by the legislation which has gained the colloquial term “Obamacare.”
How It Works
In New York the pilot project will run for about three and a half years–starting next June. Throughout that time, various changes will be made to, hopefully, improve care coordination for the nearly 170,000 New Yorkers who are dual eligible.
New York’s version of the pilot project is known as “Fully Integrated Duals Advantage.” The program will essentially work by filtering all health plans into a long-term care program monitored by Medicaid. Then, dual eligibles will have their plans altered to include expanded Medicare services.
The goals are two-fold. First, officials hope to improve care for this community. Residents who are eligible for both Medicaid and Medicare are incredibly vulnerable, often with limited resources on top of serious health challenges. By improving how the system works, the hope is that this community will be better served, receiving appropriate and timely care.
Secondly, policymakers believe that improved efficiency will ultimately save money. Right now, about 18% of Medicaid participants and 15% of Medicare participants are “dual eligible.” Yet, they make up 39% and 31% of expenditures for each respective program. In other words, by better meshing how services are delivered, inefficiencies may be rooted out with cost savings for the state.
In describing the pilot project, the New York State Health Commissioner explained, “”We are delighted to partner with CMS to offer access to more coordinated care to Medicare-Medicaid beneficiaries with long-term care needs. Providing customized services that address each individual’s medical, behavioral and social needs is critical to improving the health and well-being of this population.”