A bipartisan team of senators introduced legislation Thursday that would expand services for dual-eligible Medicare and Medicaid beneficiaries through programs such as Programs of All Inclusive Care for the Elderly (PACE). The PACE Expanded Care Act would provide more home-and-community-based care, which could include access to home care and home healthcare to the vulnerable dual-eligible population.
“There are millions of Americans eligible for both Medicare and Medicaid, but the systems are so fragmented and complex it often leads to gaps in care,” Sen. Bob Casey (D-PA), the bill’s co-sponsor, said.
During a Senate Special Committee on Aging hearing, physicians and policymakers said programs like PACE effectively coordinate primary care services, long-term care, behavioral health and social services under one roof.
“As a physician, one of the most frustrating realities of caring for dual-eligible patients is our inability to help them effectively throughout this process,” Harvard University Assistant Professor of Health Policy Jose Figueroa, M.D., told the committee. “Countless hours are spent by clinicians, care coordinators and social workers trying to determine what should be the safest discharge plan for patients. At the same time, we’re trying to coordinate their care across multiple different providers across multiple different clinics.”
PACE provides comprehensive medical and social programs to dual-eligible Medicare and Medicaid patients who qualify for skilled nursing care, but can still live in their homes and communities. The program is currently offered in 30 states and serves approximately 50,000 people.
About 12 million Americans qualify as dual-eligible beneficiaries, but only about 1 in 10 are receiving benefits from both Medicare and Medicaid, according to research by the Alliance for Health Policy.
PACE is one of three programs that provide integrated care to dual eligibles. Other programs include Dual Eligible Special needs plans (D-SNPs) and integrated state programs that fall under the CMS Financial Alignment Initiative. But applying to those programs can be cumbersome.
Jane Doyle told the committee her 87-year-old mother was spending $7,000 a month on home health care before she turned to Pennsylvania’s Medicaid program for help. Doyle said her mother had to apply for Medicaid and then apply for a separate waiver to get home healthcare under Pennsylvania’s integrated Medicare/Medicaid program.
“The process is very long and difficult,” Doyle said. “It requires several applications, documentation from both Medicaid and doctors, choosing a provider to oversee your case and finding a participating home health agency with enough staff to meet our mom’s needs.”
Separately on Thursday, Sen. Tim Scott (R-SC) introduced a bill that would provide grants to states to develop plans that would use Medicaid dollars to offer services to dual eligible patients.
