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

Share this article:
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.

Share this article:

More in News

Double homicide at Houston nursing home; victims' roommate arrested

Double homicide at Houston nursing home; victims' roommate ...

A double murder occurred late Tuesday night in a Houston nursing home room shared by four men, according to local authorities. Police arrested Guillermo Correa on suspicion of beating two ...

$2 million HIPAA settlement highlights mobile device risks facing healthcare providers

Laptops and other mobile devices containing personal health information have been stolen from long-term care ombudsman programs and other healthcare organizations, including from Concentra Health Services and QCA Health Plan Inc. Now, Concentra and QCA have agreed to legal settlements totaling nearly $2 million, federal ...

Long-term care nurses often 'scramble' to get family members' blessing for palliative ...

Nursing home residents might not transition to full palliative care until they are very near death, at which point nurses and family members act in a state of crisis, suggests recently published research out of Canada.