At an AEI event on Tuesday morning, health policy experts joined Joseph Antos to discuss how to improve care for dual eligibles, defined as people enrolled in Medicare due to age or disability status and Medicaid due to low incomes.
Melanie Bella of the Medicare-Medicaid Coordination Office began the discussion with a report of the Centers for Medicare and Medicaid Services’ (CMS) efforts to coordinate care for the dually eligible population, most notably the Financial Alignment Initiative. The initiative — currently underway in 27 states — moves dual eligibles into state-run plans supported by federal funds. Judith Feder of Georgetown University’s Public Policy Institute went on to question CMS’s decision to cede responsibility of dual eligibles to the states, given that the federal government currently spends about four times more on these individuals than the states do.
Alan Weil of the National Academy for State Health Policy framed this issue as a culture clash between the two programs: while Medicare strives to preserve choice for its beneficiaries, Medicaid often limits choice in an attempt to contain costs. Tim Schwab of SCAN Health Plan demonstrated that when designed appropriately, special needs plans for dual eligibles can play a large role in improving integration between Medicare and Medicaid.
– Catherine Griffin
Nine million low-income seniors and people with disabilities are enrolled in both Medicare and Medicaid. While many of these dually eligible individuals have multiple chronic conditions and are seeing multiple health providers, only one in ten is enrolled in managed care. As a result, these beneficiaries find themselves caught between unaligned rules and incentives across the two programs, resulting in uneven care and increased costs.
The new Financial Alignment Initiative from the Centers for Medicare and Medicaid Services (CMS) intends to improve the quality of care and reduce costs by merging program funding and allowing states to integrate all services through newly created health plans. Although better care coordination has long been a goal, experts disagree about how improved care can best be achieved, with some arguing that Medicare is abdicating responsibility for its sickest and poorest beneficiaries. The Financial Alignment Initiative has set ambitious time frames for making sweeping changes in the care offered to dual eligibles. Will dual eligibles be able to obtain the services they need once they are shifted into these new health plans? Will savings come at the expense of patient care, or will this approach lead to real efficiencies in delivering care? How will CMS know if they’ve gotten it right?
A panel of experts will discuss the potential of this demonstration to promote unprecedented coordination between the federal Medicare program and the state-run Medicaid program. Melanie Bella, director of the Medicare-Medicaid Coordination Office at CMS, will lead off the discussion. She will be joined by a panel of individuals that reflects the diversity of opinion concerning the care of the dually eligible population.
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Melanie Bella, Centers for Medicare and Medicaid Services
Judith Feder, Georgetown University
Patricia Nemore, Center for Medicare Advocacy
Tim Schwab, SCAN Health Plan
Alan Weil, National Academy for State Health Policy
Joseph Antos, AEI
Event Contact Information
For more information, please contact Catherine Griffin at [email protected], 202.862.5920.
Media Contact Information
For media inquiries, please contact Véronique Rodman at [email protected], 202.862.4871.
Joseph Antos is the Wilson H. Taylor Scholar in Health Care and Retirement Policy at AEI. He is also a commissioner of the Maryland Health Services Cost Review Commission and a health adviser to the Congressional Budget Office. Before joining AEI, Antos was assistant director for health and human resources at the Congressional Budget Office. At AEI, Antos’s research focuses on the economics of health policy, including Medicare reform, health insurance regulation and the uninsured. He has written and spoken extensively on the Medicare drug benefit and has led a team of experienced independent actuaries and cost estimators in a study to evaluate various proposals to extend health coverage to the uninsured. Antos is the co-author of the AEI paper, “A Better Prescription: AEI Scholars on Realistic Health Reform.” He is also the author of the recent New England Journal of Medicine paper, “The Wyden-Ryan Proposal: A Foundation for Realistic Medicare Reform.”
Melanie Bella is the director of the Medicare-Medicaid Coordination Office at the Centers for Medicare and Medicaid Services (CMS). Before joining CMS, Bella was the senior vice president for policy and operations at the Center for Health Care Strategies (CHCS). She led the organization’s efforts to integrate care for complex populations, including people with multiple chronic conditions, disabilities, serious mental illness and dual eligibles. In addition, she directed a unique leadership training institute to help Medicaid directors enhance the skills they need to transform their state programs into national models for high-quality, cost-effective care. Before joining CHCS, Bella served as Medicaid director for the state of Indiana from 2001 to 2005. During her tenure, one of her most notable accomplishments was spearheading the creation of the Indiana Chronic Disease Management Program.
Judith Feder is a professor of public policy at the Georgetown Public Policy Institute, where she served as dean from 1999 to 2008. A nationally recognized leader in health policy, Feder has made her mark on the nation’s health insurance system through both scholarship and public service. A widely published scholar, Feder’s health policy research began at the Brookings Institution, continued at the Urban Institute, and, since 1984, has flourished at Georgetown University. In the late 1980s, Feder moved from policy research to policy leadership, actively promoting effective health reform as staff director of the congressional Pepper Commission from 1989 to 1990, which was chaired by Sen. John D. Rockefeller IV (D-W.V.), as principal deputy assistant secretary for planning and evaluation at the Department of Health and Human Services in former President Bill Clinton’s first term, as senior fellow at the Center for American Progress (2008-2011) and, today, as an institute fellow at the Urban Institute. In 2006 and 2008, Feder was the Democratic nominee for Congress in Virginia’s 10th congressional district.
Patricia Nemore is an attorney in the Washington, D.C., office of the Center for Medicare Advocacy. Nemore has been an advocate for elderly people and people with disabilities seeking health care for more than 35 years. Her practice has focused on Medicare, Medicaid and long-term care, with special emphasis on issues of importance to those dually eligible for Medicare and Medicaid. Nemore’s recent work focuses on the dual eligible integration programs being spearheaded by the federal Medicare and Medicaid Coordination Office as well as issues affecting low-income Medicare beneficiaries’ access to and use of the Medicare Part D Low Income Subsidy and the Medicare Savings Programs. She has published articles and reports on these subjects and has been engaged in individual advocacy, class action litigation and legislative and administrative advocacy at the national level.
Tim Schwab, M.D., joined SCAN Health Plan in 1990 and now serves as chief medical officer. Before joining SCAN Health Plan, Dr. Schwab served as medical director of physicians of Greater Long Beach, an independent physicians association. He also practiced internal medicine for 10 years as a partner with Harriman Jones Medical Group based in Long Beach, California. Dr. Schwab participates in several professional organizations and formerly served as president for both the California Society of Internal Medicine and the Long Beach Society of Internal Medicine. Dr. Schwab serves on the California Olmstead Committee, was a delegate to the 2005 White House Conference on Aging and has also played an active role in several committees of the American Society of Internal Medicine and the American College of Physicians. Schwab was on the board of directors of Front Porch, a nonprofit senior housing organization, until 2012.
Alan Weil has been the executive director of the National Academy for State Health Policy since September 2004. Weil previously served as director of the Urban Institute’s Assessing the New Federalism project, one of the largest privately funded social policy research projects ever undertaken in the United States. He previously held a cabinet position as executive director of the Colorado Department of Health Care Policy and Financing, was health policy adviser to Colorado Governor Roy Romer and was assistant general counsel in the Massachusetts Department of Medical Security. Weil is the co-editor of two books, publishes regularly in peer-reviewed journals, and has testified before Congress more than six times. He is on the editorial board of the journal Health Affairs and is a member of the Institute of Medicine’s Board on Health Care Services, the Commonwealth Fund’s Commission on a High Performance Health System and the Kaiser Commission on Medicaid and the Uninsured.