Increase in dual eligibles under ACA presents opportunity for Medicaid-focused health plans, expert says

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The Affordable Care Act's Medicaid expansion incentives are too attractive for Republican governors to turn down indefinitely, predicted one health policy consultant this week. 

That's because of the rise in dual eligibles, a population that is expected to grow to 14.5 million, said consultant John Gorman. The increase of duals is expected to fuel about $200 million to $300 million in new organic growth for health plans, Gorman said at a conference sponsored by Atlantic Information Services on Thursday.

Serving those dually eligible for Medicare and Medicaid benefits “will force health plans to design ‘fundamentally different approaches,' including long-term care, “which Medicaid plans don't know a lot about,” Gorman said, according to a report by the Bureau of National Affairs.

“We're going to see all kinds of new models of care with strange bedfellows, including Medicare plans teaming up with traditional Medicaid plans,” Gorman said. Dual eligibles make up a sizable percentage of nursing home residents.

The expansion extends Medicaid benefits to people with incomes of up to 133% of the federal poverty level. While the federal government picks up the vast majority of the cost at the beginning, nine Republican maintain it will too expensive for their states over time.

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