States look to cut costs for treating dual-eligibles

Many states are using the cost-cutting impetus of the Affordable Care Act to combine their Medicare and Medicaid programs, thus saving money on the care provided for enrollees, StateLine reports.

Massachusetts has already combined the two programs to serve so-called dual-eligibles--those who qualify for Medicare but whose low incomes also mean they qualify for Medicaid--and 18 other states plan to roll out similar mergers between now and 2015.

While the dual-eligible population comprises 15 percent of Medicaid enrollees, they account for almost 40 percent of the overall costs, about $110 billion a year, according to StateLine. In Medicare, they account for 20 percent of enrollees but 30 percent of the costs, or more than $162 billion a year.

Dual-eligibles tend to be less healthy and have more healthcare needs than the Medicare and Medicaid populations in general, FierceHealthFinance previously reported. Fifty-five percent have three or more chronic conditions, compared to 44 percent of Medicare enrollees. Twenty-six percent have had at least one hospitalization, compared to 18 percent of those enrolled in Medicare. They are also 13 times more likely than Medicare enrollees to require enrollment in a long-term care facility.

Although integrating care for the dual-eligible program could wind up costing revenue for the hospitals, the move could significantly reduce their cost of care. For example, the industry could avoid up to 40 percent of the hospitalizations of low-income nursing home residents if the population had better care. But since Medicare pays for their hospitalization, organizations have never had any incentive to do so, according to StateLine.

Some hospital interests have pushed back against the implementation of integrated dual-eligible care. The Federation of American Hospitals, which represents for-profit facilities, has expressed concern that the transition is occurring too rapidly. It suggested implementation on a limited geographical basis, FierceHealthcare previously reported.

To learn more:
- read the StateLine article