A newly formed alliance of healthcare and consumer organizations has formed to advance the integration of Medicare and Medicaid for dually eligible nursing home residents and other older adults.
“People who are dually eligible make up a large portion of nursing home residents, and the outcomes they experience today are suboptimal,” Mark E Miller, PhD, told the McKnight’s Business Daily.
Miller is executive vice president of healthcare at Arnold Ventures, a founding member of the new Medicare-Medicaid Integration Alliance. Other founding members include the Association for Community Affiliated Plans, Community Catalyst, Justice in Aging and the Medicare Rights Center.
Almost 1 million dually eligible older adults live in skilled nursing facilities, and the rates of potentially avoidable hospitalizations among those residents is almost triple that of residents who are not dually eligible, Miller said.
“Drawing on decades of research, case work and advocacy, the consumer and healthcare organization members of the MMIA have identified the fragmentation of Medicare and Medicaid as a key barrier to care for the Medicare-Medicaid population,” MMIA said in a press release.
The alliance said it will work to ensure that people have access to meaningfully integrated coverage, support informed decision-making and easier enrollment in coverage by providing people with the necessary resources and see that integrated coverage meets people’s needs and goals.
“In our vision, there isn’t a handoff between Medicare and Medicaid; there is a seamless, integrated and holistic experience for dual eligible people regardless of where they live, including in nursing homes,” Miller said.
Assisted living residents are less likely to be affected by efforts to integrate Medicare and Medicaid, Miller said, because such settings often are not covered by Medicaid and residents are not dually eligible.
Congress has taken steps to improve integration of Medicare and Medicaid, although application differs widely among the states, according to MMIA. Many dually eligible individuals, therefore, lack healthcare coordination, the group said.
“Integration is intended to care for the patient in the ideal setting (home or facility) given their needs and preferences, to help them maintain the highest level of function and to avoid events that suggest poor quality care such as ER visits and hospitalizations,” Miller said.
