Government officials face increased pressure over troubled dual-eligible initiative

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A long-criticized project to improve the healthcare delivery and payment system for people eligible for both Medicare and Medicaid has again been under fire in recent days, prompting government officials to defend the slow pace of implementation.

The Centers for Medicare & Medicaid Services launched the Financial Alignment Initiative in July 2011. The project's goal is resolving contradictions in the administration of Medicare and Medicaid, which are negatively affecting care for the dual-eligible population. Many dual-eligibles are elderly, chronically ill residents of nursing homes.

The initiative was sharply criticized by lawmakers after a progress report was released in December 2012. Sen. John D. Rockefeller (D-WV) called it a “so-called demonstration” in a hearing. He blasted it for placing many Medicare beneficiaries in managed care programs, which he said “have not demonstrated success with even small numbers of dually eligible beneficiaries.”

More recently, news outlets reported that many of the 26 states involved in the demonstration have pushed back start dates or are moving away from their original proposals. New Mexico dropped out entirely.

Melanie Bella, director of the Medicare-Medicaid Coordination Office at CMS, defended the program to Rockefeller in December, and she defended it again this week.

“We're not in a rush to implement,” Bella told the Bureau of National Affairs. “We're in a rush to get it right.”

Bella said the program is not foundering and emphasized that states can tweak the initiative so that it works in particular insurance markets. However, a different CMS official, speaking on condition of anonymity, confirmed reports that six states are pushing back their start dates and five others are altering their plans, BNA reported.


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