A bipartisan bill sponsored on May 22 by U.S. Rep. Mike Kelly (R-PA) would enhance healthcare coverage for Americans who are jointly enrolled in Medicare and Medicaid.
Also known as dual eligibles, these individuals would receive improved care under newly established integrated care programs provided by states that get support under the Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024, H.R. 8503, which is cosponsored by U.S. Rep. Ami Bera (D-CA).
“We are always striving to find the best way possible to serve patient needs, improve patient outcomes, and ultimately strengthen Medicare and Medicaid programs,” Rep. Kelly said. “This legislation will improve coverage for Americans enrolled in both programs and will ultimately save taxpayer money.”
If enacted, H.R. 8503 would require each state, with support from the Centers for Medicare & Medicaid Services (CMS), to select, develop, and implement a comprehensive, integrated health plan for dual-eligible beneficiaries. States can create a new system or build off of existing coverage options, according to a bill summary provided by Rep. Kelly’s staff.
Additionally, H.R. 8503 would require plans to develop and update care coordination plans, require the establishment of ombudsman offices, and establish a care coordinator for each beneficiary, the summary says.
Among several provisions, the proposed measure also would reduce “look-alike” plans that target dual eligibles for enrollment but don’t provide any coordination, create a single appeals process instead of the current Medicare and Medicaid appeals process, and reduce third-party marketing organization incentives to target beneficiaries, states the summary.
The DUALS Act of 2024 is supported by the Association for Community Affiliated Plans, PointClickCare, the American Kidney Fund, the National Multiple Sclerosis Society, the Alliance of Community Health Plans, and the Bipartisan Policy Center, among others.
“Patients who are dually eligible for Medicare and Medicaid should not face poor health outcomes due to the bureaucratic patchwork of our health care system,” said Rep. Bera. “This bill takes a critical step forward in ensuring that some of the most vulnerable Americans receive the integrated and quality care that they deserve.”
H.R. 8503 is companion legislation to the same-named S. 3950, introduced on March 14 by bill sponsor U.S. Sen. Bill Cassidy (R-LA) and lead original cosponsor U.S. Sen. Tom Carper (D-DE), who are members of the Senate Duals Working Group.