Cassidy leads effort to improve Medicare, Medicaid coverage for dually eligible enrollees

As they develop legislation to improve coverage for dual eligibles, U.S. Sen. Bill Cassidy (R-LA) and a bipartisan group of his colleagues seek feedback from the healthcare and patient communities on how to do so for the roughly 12.2 million low-income or disabled people in the United States jointly enrolled in Medicare and Medicaid.

Specifically, the senators seek more detailed information on existing data and improving beneficiary care for this diverse group, which includes individuals with multiple chronic conditions, physical disabilities, mental illness, and cognitive impairments such as dementia and developmental disabilities, as well as others who are relatively healthy, according to a Nov. 23 letter they sent out for comments. 

“Dual eligibles, while representing a small proportion of Medicare and Medicaid beneficiaries, account for a disproportionate share of overall spending,” wrote Sen. Cassidy and his colleagues. “Combined Medicare and Medicaid spending on dual eligibles rose to a total of $440.2 billion in 2019, with $164.3 billion of it being Medicaid spending.” 

They noted that while the complex set of conditions represented by this population contributes to this high cost, the current fragmented and disjointed system of care for dual eligibles is also to blame, according to their letter.

“Most dual eligibles today are covered by two separate Medicare and Medicaid plans that do not coordinate care nor align enrollment,” the senators wrote. “This discordance can potentially lead to both poor outcomes for patients and inefficient spending for the health care system.” 

At the same time, the COVID-19 pandemic further exposed the need for reforms to systems of care for dual eligibles, they wrote, citing federal data showing that across every demographic group, dual eligibles were more likely to contract COVID-19. 

“More concerning, dual eligibles were more than three times as likely to be hospitalized from COVID-19 compared to Medicare-only individuals,” wrote Sen. Cassidy and five of his colleagues, who included U.S. Sens. Tim Scott (R-SC) and Mark Warner (D-VA).

The lawmakers requested specific information regarding shortfalls in the current system of care for dual eligibles, how to improve patient health outcomes and the role of federal or state governments in dual eligibles’ care. 

“It is time to reform care for dual eligibles now before the next wave of COVID-19 or another pandemic leads to high morbidity and mortality for these vulnerable individuals,” Sen. Cassidy and his colleagues wrote.