As at least 24 U.S. states prepare to move their oldest and sickest citizens from the government’s Medicare and Medicaid health programs into managed-care plans, insurers are figuring out the best way to profit.
The industry today is holding the first-ever conference on covering so-called dual eligibles, people who are both old enough to qualify for Medicare, and poor enough to be put on Medicaid. Such residents tend to cost states more money because the combination of their ages and economic statuses often translates into more complicated and expensive health ailments.
More than 9 million people are in that category, according to the nonprofit Kaiser Family Foundation, based in Menlo Park, California. While states had been hesitant to put poor elderly residents into managed-care plans out of concern for the quality of their care, recent budget constraints and rising health costs have left them searching for a better solution.
While dual-eligibles comprise about 15 percent of the Medicaid population, they account for about 40 percent of the program’s spending because of complicated health problems, such as dementia, according to Kaiser.
“The innovative programs and services health plans have pioneered can help improve care for beneficiaries dually eligible for Medicare and Medicaid and help put these programs on sustainable and fiscally-responsible paths,” Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, the industry’s Washington-based lobby group, said in an e-mail.
He said the summit, which his group organized, “is an opportunity to showcase these initiatives.”
Twenty-four states plus Washington, D.C., enrolled at least some of their dual-eligibles in managed care as of 2010 according to data from Kaiser.
Florida was awarded a waiver last month from the U.S. Health and Human Services Department to put almost all of its Medicaid beneficiaries into managed-care plans, including people dually eligible for Medicare. California is testing the idea of managed care for dual-eligibles this year, according to Bloomberg Industries.