ICYMI: Senator Carper and Colleagues Introduce Bipartisan Legislation to Improve Dual-Eligible Care

In Case You Missed It, U.S. Senator Tom Carper (D-Del.), joined a bipartisan group of lawmakers last week to introduce the Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024. This legislation would improve coverage for individuals jointly enrolled in Medicare and Medicaid, also known as dual eligibles.

See more in the WDel.com, Newsweek, WGMD (radio), Axios, Politico, and The Washington Post:

Improving Care for ‘dual eligibles’
By: Mike Phillips

Listen to the WDEL 101.7 radio story here.

A group of United States Senators, operating under the title the Duals Working Group, announced new legislation aimed at improving care for patients jointly enrolled in Medicare and Medicaid.

Senator Tom Carper (D – DE) was among the senators who spoke at a news conference Thursday, March 14, 2024, in Washington, D.C.

According to the senators, a small proportion of Medicare and Medicaid beneficiaries, called dual eligibles, account for a disproportionate share of overall spending.

“Medicare and Medicaid have little to no coordination when it comes to patients who are enrolled in both programs, and that makes providing resources and caring for dual eligibles difficult, real difficult,” said Carper.

“Medicaid and Medicare cannot continue to operate in silos,” added the Senator. “At long last our legislation, I think, begins to change that.” […]

Medicare, Medicaid Plans Could Drastically Change
By: Suzanne Blake

Dual enrollees of Medicare and Medicaid could see big changes ahead as a bipartisan group of U.S. senators proposed a new law to integrate the two plans in a more seamless program. […]

Carper said that beneficiaries who are dually eligible for Medicare and Medicaid tend to be some of the sickest and most vulnerable patients, and ending the complexity behind the health care programs is key in the bill.

“We’ve worked hard over the last three years to draft this legislation, and I’m proud to introduce the product of our years of work today,” Carper said. […]

WGMD

“Senator Tom Carper is highlighting a bill he says will help people eligible for both Medicare and Medicaid. He says those so-called ‘dual eligibles’ are some of the sickest and most vulnerable patients.

[Senator Carper]: “Some of the sickest people, the most expensive people to take care of, are those who are in both Medicaid and Medicare. They often times get overlooked in health care reform, but not today.”

Carper and a group of Senators have been working on that bill for almost a year.”

Senate plan would coordinate dual-eligible care
By: Victoria Knight

A bipartisan group of senators on Thursday outlined a plan for integrating Medicare and Medicaid services for the millions of people who are eligible for both programs.

Why it matters: The programs aren’t linked, and so-called dual eligibles often have trouble navigating between them to obtain care, long-term services and medical equipment.

What’s inside: The DUALS Act of 2024 would require states and CMS to develop and implement a single integrated health plan for all dual-eligible beneficiaries. It would designate a care coordinator for each beneficiary to help assess plan offerings, as well as try to reduce third party marketing of multiple plans targeted at beneficiaries.

The legislation is sponsored by Sens. Bill Cassidy, Tom Carper, John Cornyn, Mark Warner, Tim Scott and Bob Menendez. The group has been working on the bill for several years.

By the numbers: 12.2 million Americans are jointly enrolled in Medicare and Medicaid. Often these are low-income patients with complex medical needs. […]

Congress seeks to reform profitable Medicare-Medicaid plans
By: Robert King and Megan Wilson

The legislation is the product of a working group that includes Sens. Tom Carper (D-Del.) and Bill Cassidy (R-La.) following input from health plans, states, and other players.

[…] What it does: The legislation requires each state to have at least one integrated health plan for dual eligibles. Each of these plans also must have a care coordinator, which could cost insurers more money. Plans must hire an ombudsman to act as an advocate for older Americans.

It also seeks to reduce the number of “look-alike” plans, which may seem like a duals plan but don’t offer any coordination or abide by Medicare and Medicaid rules for duals plans.

The bill would reduce incentives for third-party marketing organizations to target potential dual beneficiaries.

Lawmakers also want to require each state to establish the Program of All-Inclusive Care for the Elderly (PACE). The program offers increased care toward elderly and frail older Americans, many of whom are eligible for a duals plan. There are currently 17 states that do not have a PACE program. […]

Next steps: There are efforts to introduce a companion in the House. While some insurer industry groups have yet to weigh in, the Alliance of Community-affiliated Health Plans is supportive of the effort.

Senators introduce bill to streamline dual-eligible care
By: Julie Rovner

[…] A bipartisan group of senators unveiled a plan yesterday aimed at improving coverage for the 12.2 million Americans enrolled in both Medicare and Medicaid.

The details: The DUALS Act of 2024 would require each state, with assistance from the Centers for Medicare and Medicaid Services, to develop and implement an integrated health plan tailored to dual-eligible beneficiaries.

The bill would also establish a care coordinator for each enrollee, reduce “look alike” plans that target dual-eligible beneficiaries without aligning benefits, and create a single appeals process for both safety-net programs, among other actions.

Sponsored by Sens. Bill Cassidy (R-La.), Tom Carper (D-Del.), John Cornyn (R-Tex.), Mark R. Warner (D-Va.), Tim Scott (R-S.C.), and Bob Menendez (D-N.J.), the legislation has been in the works since November 2022. […]

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