Dual eligible pilots proving pricey, time-consuming for states

States did not anticipate the high cost of modifying their IT systems, the report found
States did not anticipate the high cost of modifying their IT systems, the report found

Many states are finding the “nuts and bolts” of coordinating care for dual eligible beneficiaries to be more costly and time consuming than they anticipated, according to a new report.

The report, completed for the Centers for Medicare & Medicaid Services by research firm RTI International, analyzed dual-eligible demonstration pilots in California, Illinois, Massachusetts, Minnesota, Ohio, Virginia and Washington. The analysis was completed in October, and released online last week.

RTI's analysis found that many state officials did not anticipate the time it would take to align Medicare and Medicaid program policies, systems and procedures. Many states also reported underestimating the “extensive financial investments” required to modify their IT systems for the pilots.

Beneficiary materials, Medicare-Medicaid plan compliance processes and appeals processes were plagued by “program misalignment,” state officials noted. Many also complained that for daily operational policies where the two programs differ they had “little choice but to accept Medicare processes” instead of ones tailored to their state provisions.

Early findings also showed enrollment started more slowly than planned, with the majority of beneficiaries entering the programs through passive enrollment. Many enrollees were not familiar with how managed care works, leading to staff having to spend an “inordinate amount of time” finding the enrollees to complete health assessments and introducing them to the benefits of the pilot, the report noted.

The report comes just days after the U.S. Government Accountability Office released its own report calling for increased oversight for dual-eligible pilots and additional measures to better understand how care coordination is working.