Patients Eligible for Medicare and Medicaid Face Fragmented Coverage
Elderly and disabled individuals who qualify for both Medicare and Medicaid often face discontinuity in care because the two programs have different designs and funding structures, according to a recently released report by the University of Maryland's Center on Aging that highlights challenges faced by those with dual eligibility. The report, which discusses how case management can alleviate such challenges, is the first of several to be released over the next few months on potential solutions to the "fragmentation" in Medicare and Medicaid and on providing more effective coverage for the elderly and disabled. An estimated six to seven million individuals, primarily the elderly and disabled, qualify for both Medicare and Medicaid benefits. The report found that it "is surprisingly difficult" to actively engage such individuals and their families in care decisions. Other challenges for dual-eligibility patients lie in facilitating the doctor-patient relationship and effectively linking community-based services that allow the chronically ill to remain in their homes. The report highlights areas in the United States that are part of the Medicare/Medicaid Integration Program, an initiative supported in part by the Robert Wood Johnson Foundation and directed by the UM Center on Aging that aims to "end the fragmentation of financing and service delivery that currently exists between" the two government programs. MMIP participant Minnesota, for example, is running a demonstration project for dually eligible individuals called Minnesota Senior Health Options that includes a series of focus groups attended by health plans, providers, beneficiaries and caregivers. The report found these forums increased communication between the different parties and allowed participants to develop a better understanding of case managers' needs and roles. Mark Meiners, associate director of the Center on Aging and head of the MMIP effort, said, "There is a growing recognition that chronic illness and disability will become more common as our population ages and we will want Medicare and Medicaid to work well together in providing care" (Center on Aging release, 12/8). The report is available at http://www.inform.umd.edu/EdRes/Colleges/HLHP/AGING/MMIP/Case_Mgm t.pdf.This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.