A study finds that dual-eligible beneficiaries face confusing and often conflicting regulations from Medicare and Medicaid when it comes to accessing durable medical equipment, according to a recent academic article published in HealthAffairs.
Here’s an example: Medicare requires enrollees to use DME predominantly for in-home use, whereas Medicaid can cover equipment that will be used outside of the home. But, since Medicaid must be the “payer of last resort,” dual-eligible beneficiaries are often forced to receive a denial from Medicare before Medicaid will cover their equipment. In the meantime, these beneficiaries may be left without their needed DME until they spend the time and energy jumping through these bureaucratic hoops.
Medicaid prior authorization requirements can also lengthen the amount of time a beneficiary is left without the equipment they need.
On the supply end, some DME vendors may only participate in Medicare or Medicaid, limiting the selection for dual-eligible beneficiaries. Furthermore, a person with complex health needs or insurance coverage may be overlooked by some vendors, as “DME suppliers may preferentially work with individuals whose cases are less complicated,” the article noted.
In related news, on Sept. 8, Rep. John Joyce (R-PA) introduced the Choices for Increased Mobility Act of 2023, which would modify this Medicare code to grant beneficiaries access to wheelchairs made from alternative materials such as carbon fiber or titanium. Current Medicare regulations may prevent some people from using wheelchairs made from these materials, according to the American Association for Homecare. Beneficiaries must instead use the heavier and less durable aluminum equipment.
“Individuals should have the ability to choose whether a titanium or carbon fiber wheelchair is right for them,” the association said in a statement. “The legislation to enable upgrades within a code removes the current obstacles in place, offering key benefits to end users at no additional cost to CMS”
CMS has granted some flexibility regarding DME in recent months. In May, it issued a decision to allow seat elevation on Medicare-covered powered wheelchairs, which was previously a barred modification.