Shift long-term care payment responsibility from Medicaid to Medicare, research group suggests

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In order to better coordinate care for nursing home residents who are dually eligible for Medicare and Medicaid, responsibility for long-term nursing facility services should be shifted from Medicaid to Medicare, suggests a recently released policy brief from policy research group Mathematica.

More than half of all nursing facility residents are dual-eligibles, according to the policy brief. It is projected that 42% of all nursing home funding will come from Medicaid in 2010, while Medicare will provide only 20%. Roughly 35% will come from private pay, according to the brief. Lead author James Verdier acknowledges the large leap it would take to shift nursing facility funding from Medicaid to Medicare, but he suggests a series of incremental moves that could ease the transition.

Potential steps that could lead to better coordination of care for dual-eligibles, according to Verdier, include: shifting responsibility for prescription drug use in nursing facilities to Medicare Part D plans that specialize in those services; provide pay-for-performance incentives to nursing facilities to prevent avoidable hospitalizations; ensure that Medicaid-funded home- and community-based services coordinate with facility-based care after facility-based care becomes Medicare's responsibility.

For more information or a copy of the policy brief, visit the Mathematica Web site.

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