Mass. joins effort to blend care of people eligible for both Medicaid and Medicare

Massachusetts is one of seven states taking part in a program designed to improve care and control costs of people who receive healthcare coverage through both Medicaid and Medicare, the state said.

The Transforming Care for Dual Eligibles initiative, designed by the Center for Health Care Strategies and supported by The Commonwealth Fund, seeks to coordinate fragmented care that people may be receiving, in order to reduce unnecessary hospitalizations and cut down on the need for care in long-term facilities.

All people over age 65 and certain disabled persons automatically have Medicare Part A coverage for their hospital expenses. Medicare Part B, which covers physician services, lab and X-ray services, durable medical equipment, and outpatient services, requires payment of monthly premiums. Medicaid offers healthcare coverage based on income or disability. Some people use Medicaid benefits to pay for outpatient Medicare services.

People who qualify for both kinds of coverage are more likely to have lower income combined with more complicated medical, behavioral, and long-term health problems than people who qualify for either Medicaid or Medicare alone. Their costs that are nearly five times those of other Medicare beneficiaries.

Nationally, dually eligible people make up about 18 percent of the Medicaid population, but account for 46 percent of the program's costs. In Massachusetts about 230,000 people with health coverage through MassHealth, the state's Medicaid plan, had dual eligibility last year.

MassHealth’s Senior Care Options and the Program of All Inclusive Care for the Elderly already integrate Medicare and Medicaid for people over 65, the state said, but the new initiative will extend the coordination to other MassHealth members.

Other states in the 18-month program are Colorado, Maryland, Michigan, Pennsylvania, Texas, and Vermont.

The Center for Health Care Strategies is a non-profit health policy group and The Commonwealth Fund is private foundation that supports research on health policy and healthcare.