Dual-eligibles demo failing to meet expectations, MedPAC says

A demonstration program aimed at improving care for beneficiaries eligible for both Medicare and Medicaid is showing lower enrollment than expected, according to a Medicare Payment Advisory Commission staff member.

Enrollment in the demo varies by state, ranging from 70% in Ohio to less than 10% in New York, Eric Rollins, a MedPAC principal policy analyst, said during a presentation on Friday. Overall 30% of eligible beneficiaries are enrolled in a Medicare-Medicaid plan, which is “lower than what many observers expected,” Rollins said.

Issues with locating eligible enrollees, as well as resistance from providers, are likely to blame for the demo's low enrollment numbers. The dual plans have also faced issues with payment adequacy, but payments are expected to increase in 2017, Bloomberg BNA reported.

MedPAC Commissioner Craig Samitt also noted issues within the program's care coordination, and the ability to measure quality with “such a distinct population.” He said the group may offer recommendations on the program to the Centers for Medicare & Medicaid Services if they “feel this is really leaving the tracks,” including how the Medicaid, Medicare Advantage and special needs programs have handled such issues.

“Maybe the solution is taking the best of what works in these various other programs and reconstructing the [dual-eligibles] program,” Samitt said.

There are currently 61 Medicare-Medicaid plans participating in the demo in Virginia, Massachusetts, Illinois, Ohio, California, Texas, South Carolina, Michigan, New York, Minnesota, Colorado and Washington. Rhode Island will complete its demo program later this year.