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The U.S. Senate Special Committee on Aging held Examining Medicare and Medicaid Coordination For Dual Eligibles, a hearing on July 18 that focused on state-specific programs for dual eligible individuals as well as the newly launched Center for Medicare and Medicaid Services (CMS) care integration projects.
Members of the committee raised concerns, particularly about some states’ requests to allow them to enroll patients in plans without first asking whether they want to join, a process known as “passive enrollment.” "The issue of “passive enrollment,” or enrolling Medicare beneficiaries in a program without their consent, is a fundamental question of beneficiary choice, which we cannot simply sweep under the rug," Sen. Herb Kohl said in his opening remarks.
Dory Funk, M.D., the medical director at Senior Community Care, in Eckert, CO, a Program of All Inclunsive Care for the Elderly (PACE) operated by the Volunteers of America (VOA), testified about the success of the PACE.
Dr. Funk said that the population of duals served by PACE could grow even faster if the operational flexibilities described in his testimony were encouraged and applied to a broader range of PACE organizations.
Jason A. Helgerson, medicaid director of the New York State Department of Health, said that PACE will also be an option for dual eligible individuals in NY. Robert Berenson M.D., and Institute Fellow at the Urban Institute, said that there is little experience and limited data to support policy making on integrated care for dual eligibles.
Helgerson recommended that CMS should scale down this demonstration to one that might involve as many as 500,000 dual eligibles.
Today, 86 PACE providers serve approximately 25,000 enrollees in 29 states, and 90% of their participants are dually eligible for both Medicare and Medicaid.
On any given day, PACE enables over 90% of its participants to remain living in their homes, rather than residing permanently in nursing homes.