Integrated Care Initiative

Michigan’s Medicaid system is involved in a project to better integrate the care provided to Medicaid recipients who also have Medicare coverage. These recipients are referred to as “dually-eligible.”

In an ideal world, it would not make any difference whether your care were covered by Medicare, Medicaid, or private insurance. If you had an ingrown toenail or a torn ACL, you would go to the same doctors and get the same effective, reasonable treatment. At least that would be my ideal world. Patient Protection and Affordable Care Act (“Obamacare” to the President’s enemies) opponents would define “ideal world” as one in which only those willing and able to pay would get care.

In this world, Medicare and Medicaid are different programs, with different sets of covered services, different financial costs to participants, and different sets of providers – try to find a dentist who accepts Medicaid. One glaring example is long-term care. Medicare covers up to 100 days of rehabilitation or skilled care after a three-day inpatient hospitalization. After that, long-term care in a nursing home is at the patient’s expense unless he or she has long-term care insurance or Medicaid. Basic nursing care is a service that is covered by Medicaid, but not by Medicare. Other services may be covered by both, but there will still be differences in how the services are authorized, provided, and paid.

Think about all the differences between private health insurance plans. What is covered, what the insured pays, and who provides the services can be greatly different depending on whether the patient has a Blue Cross or a Health Alliance Plan card.

The Integrated Care Initiative is an effort by the Centers for Medicare and Medicaid Services (CMS) to integrate care for individuals who have both Medicare and Medicaid. The idea is to provide the full array of Medicare and Medicaid benefits through a single delivery system. CMS hopes that it will be possible to provide quality care to dually eligible beneficiaries, better care coordination and fewer administrative burdens. At least that is the “company line.”

The Initiative may be dismissed as the equivalent of bureaucratic self-abuse by critics who assume that anything the government does will be inefficient, pernicious, misguided, and dysfunctional. Medicare and Medicaid are, by definition, bureaucracies. So are private insurance companies, private telecommunications providers, automobile manufacturers, and banks. Barring a TEA Party sweep of the 2012 elections, Medicare and Medicaid will continue to serve millions of U.S. citizens. The Integrated Care Initiative is an effort at better serving those who are covered by both programs. The Initiative may fail to make any significant improvement, but the fact that CMS is attempting to do its job better should be recognized as a positive development.

 

John B. Payne, Attorney
Garrison LawHouse, PC
Dearborn, Michigan 313.563.4900
Pittsburgh, Pennsylvania 800.220.7200
law-business.com
 
©2011 John B. Payne, Attorney
 
 
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