N.Y. dual-el­i­gi­bles demo en­roll­ment drop­ping

Modern Healthcare - - REGIONAL NEWS - —Vir­gil Dick­son

New York’s experiment to bet­ter co­or­di­nate care for low-in­come and dis­abled state res­i­dents who are du­ally el­i­gi­ble for Med­i­caid and Medi­care is los­ing hun­dreds of ben­e­fi­cia­ries.

Be­tween Au­gust and Septem­ber, nearly 400 peo­ple dropped out of the Fully In­te­grated Du­als Ad­van­tage pro­gram, which aims to bet­ter co­or­di­nate care for dual-el­i­gi­ble ben­e­fi­cia­ries. En­roll­ment fell from about 7,600 to 7,280 as of Sept. 1. More than 124,000 peo­ple are el­i­gi­ble for the pro­gram. Pa­tients, of­ten low-in­come and el­derly, have trou­ble nav­i­gat­ing the sep­a­rate Medi­care and Med­i­caid pro­grams, their mul­ti­ple doc­tors and other providers. That drives up the cost of their care and leads to poorer out­comes.

In New York alone, du­ally el­i­gi­ble pa­tients col­lec­tively cost $36 bil­lion across the two pro­grams, ac­cord­ing to a 2012 United Hos­pi­tal Fund re­port.

Nei­ther state of­fi­cials nor stake­hold­ers could say why en­rollees were drop­ping out. “En­rollees are happy that they are able to ac­cess ser­vices more easily than be­fore,” said Krystal Scott, New York state pol­icy di­rec­tor at the Medi­care Rights Cen­ter. “They also en­joy the fact that they have a team of providers help­ing them reach their healthcare goals, ac­cess care and live at home in their com­mu­nity.”

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