CMS is taking heat for its Medicare-Medicaid dual eligible demonstration program -- but not for the reason you might think.
According to its critics, the 15-state program isn’t really a demo at all, since the state proposals, if approved, would serve 3 million patients, or roughly 40% of the nation’s full-benefit duals, according to a MedPAC letter to CMS.
Not only does that exceed CMS’ target enrollment for the demos of 1-2 million beneficiaries, the letter states, but it indicates the demos would be executed too rapidly and instead ought to initially serve fewer of these extremely complicated and expensive patients.
Another criticism of the demos, as pointed out by Sen. Jay Rockefeller (D-W.Va.) in his own letter to CMS, is that they prioritize savings over patient care.
But since duals account for a reported 15% of the Medicaid population and 40% of the costs, there is pressure to avoid any more delays in reforming the structure of care provided to them. But if MedPAC and Rockefeller’s criticisms pick up steam, that Jan. 1, 2013 implementation date that CMS anticipated for the demos might become less realistic.
Details of the 15 states’ proposed efforts to treat Medicare-Medicaid dual eligibles can be found here.