MedPAC: Promising care models for dual eligibles face challenges

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Problems persist when it comes to enrolling seniors dually eligible for Medicare and Medicaid into integrated care programs, Medicare Payment Advisory Commission staff recently said.

During a discussion last week, MedPAC analyst Christine Aguiar told the panel that both provider groups and beneficiary advocates are resisting integrated care models for the low-income elderly, the Bureau of National Affairs reported. Providers worry that Medicare and Medicaid reimbursements will be redirected towards integrated care programs and away from nursing homes.

Integrated care programs have resulted in more primary care and less hospital and nursing home care for those who enroll, according to Aguiar. Still, Medicare and Medicaid's conflicting rules plague the programs. Enrollment in integrated care programs also is low. The 13-year old, 30-state Program of All-Inclusive Care for the Elderly (PACE) only serves approximately 18,000 individuals, BNA reported.

New provisions in the healthcare reform law could make it easier for Medicare and Medicaid to align their programs though establishment of a CMS Office of Federal Coordinated Health Care, MedPAC staff said at the meeting. Although there will be further research into coordinated care efforts will in the run-up to MedPAC's June report, there are no plans for that report to include new recommendations for the programs.