The Patient Protection and Affordable Care Act, signed into law in March 2010 by President Barack Obama, offers new benefits and federal programs for patients that are dually eligible for both the Medicare and Medicaid programs.
Overall, there are 9 million Medicaid beneficiaries throughout the country who also qualify for the Medicare program. These dual eligibles include low-income seniors and young patients with disabilities. Dual eligibles are often among the lowest income and chronically ill citizens covered by Medicaid and Medicare, and consequently, they have significant medical and long-term service needs that cost more per capita than other individuals that receive Medicare or Medicaid benefits. Though they make up a small portion of the overall Medicare and Medicaid beneficiaries throughout the country, they account for about $300 billion in annual spending across both programs.
The Affordable Care Act established two new federal agencies with the goal of improving healthcare services for dual eligibles. Those agencies are the Center for Medicare and Medicaid Innovation, also known as the Innovation Center, and the Federal Coordinated Health Care Office, or the Medicare-Medicaid Coordination Office.
One of the main goals of the Innovation Center will be to develop new healthcare models that make it easier for physicians, nurses and other caregivers to work together to care for patients.
The other new federal office, the Medicare-Medicaid Coordination Office, is working with the Medicaid and Medicare programs, individual states and consumers to coordinate benefits between the two programs.
Under the Medicare-Medicaid Coordination Office, 15 states have been selected to design new approaches to better coordinate care for dual eligible individuals. The states selected to receive design contracts are California, Colorado, Connecticut, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington and Wisconsin.
The healthcare reform law provides states with up to $1 million in funding through the Centers for Medicare and Medicaid Services for technical assistance for states to develop new delivery systems and payment coordination models that can be tested and replicated in other states.
Other provisions in the Affordable Care Act meant to improve access to care for dually eligible beneficiaries include:
- Medicare coverage for annual an wellness check-up and Medicare and Medicaid coverage for preventive services: Effective Jan. 1, 2011.
- Elimination of cost-sharing for certain full benefit dual eligible individuals: Effective Jan. 1, 2012.
- Medication therapy management programs for enrollees of Medicare Part D: Effective Jan. 1, 2013.
- Demonstration project to test a home-based primary care delivery model for Medicare beneficiaries with chronic conditions. Effective Jan. 1, 2012.
- New Medicaid option to provide health homes for beneficiaries with chronic illnesses.
- Five-year Medicaid waivers for dual eligibles.
- Medicaid Community First Choice Option, which allows states to provide home and community-based services to individuals who require an institutional level or care and who have incomes up to 150 percent of the federal poverty level.
- Funding for states with Medicare and Medicaid beneficiaries that transition from institutional care to the community: Extended through 2016.