MedPAC worried over managed care plan for dual eligibles

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A Medicare advisory panel has expressed concern that automatic enrollment into managed care plans for dually eligible Medicare and Medicaid beneficiaries would harm their access to healthcare.

Under a Centers for Medicare & Medicaid Services demonstration project, dual eligibles would be “passively” enrolled in managed care plans. Under this model, a state, CMS and a health insurance plan will enter into a three-way contract that pays the plan a blended capitated rate for the continuum of benefits. States would likely determine how much notification beneficiaries get before being enrolled, and how much time they have to opt out. Medicare Payment Advisory Commissioners debated the CMS proposal Thursday.

Dual eligibles — who often are nursing home residents — use nearly twice the percentage of Medicare and Medicaid resources as people who receive benefits from just one of the programs. The commissioners said they are worried beneficiaries would feel “locked” or “pushed” into plans that could cause them to switch providers.

The panel also discussed the possibility of reforming Medicare's fee-for-service benefits design. MedPAC is planning on releasing a report to Congress in June, according to an issue brief.