Report proposes changes to streamline care for dual eligibles

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Elderly dual eligibles, individuals who receive Medicare and Medicaid benefits, are at risk for experiencing substantial drops in care when moving between Medicare and Medicaid coverage, a new report shows.

Low-income dual eligibles, who represent a significant portion of nursing home residents, often encounter lapses in prescription drug coverage or miss out on vital physical therapy treatments due to poor coordination of care provided by these federal programs. The report, published by the National Senior Citizens Law Center with the SCAN Foundation, recommends several ways to re-align care and improve communication between the government agencies.

The report stresses that models for many of the proposed changes are already in place in some states but require better enforcement. “Even perfect synchronization of benefits will not meet the needs of dual eligibles if the underlying benefits are inadequate, if payment structures are insufficient to assure an adequate provider network, or if eligibility criteria are so restrictive that individuals cannot qualify for the services they need,” the report states.