Bill Overview
Title: Supporting Care for Dual Eligibles Act
Description: This bill establishes and provides funds for grants to support the provision of services to those who are dually eligible for Medicare and Medicaid. Specifically, the bill establishes and provides funds for FY2022 for the Dual Eligible Quality Care Fund. The Centers for Medicare & Medicaid Services (CMS) must use the funds for grants to state Medicaid programs to support quality integrated care for dual eligible beneficiaries, including technology improvements, staff support, and administrative services for beneficiaries. The bill also requires the CMS to biennially audit state Medicaid programs with respect to improper payments; states must also submit plans for mitigating improper payments.
Sponsors: Sen. Scott, Tim [R-SC]
Target Audience
Population: Individuals who are dually eligible for Medicare and Medicaid
Estimated Size: 12300000
- The bill targets individuals who are dual eligible beneficiaries of both Medicare and Medicaid.
- Dual eligible individuals are usually seniors or individuals with disabilities who have low income.
- Approximately 12.3 million people are estimated to be dual eligible beneficiaries in the United States.
- The bill aims to improve the care quality for these individuals through state Medicaid programs.
Reasoning
- The policy targets dual eligibles, who often face challenges such as complex medical and social needs, limited resources, and navigating multiple service systems. These individuals would likely benefit directly from improvements in integrated care services, reducing the burden of managing their health care needs.
- The policy's budget constraints mean not all dual eligibles will see immediate or dramatic changes. The fund allocation must balance between impactful improvements, such as technology and staffing, and cost efficiency.
- Given an estimated population of 12.3 million dual eligibles, and the budget constraints, not all will be affected equally. The implementation is likely to focus on states or regions with higher concentrations of dual eligibles and greater historical challenges with improper payments or care integration.
- Dual eligibles might experience improvements in wellbeing if the policy is implemented effectively, focusing on integrated care which can enhance access, reduce medical errors, and improve patient satisfaction.
- By auditing and reducing improper payments, the policy could redirect funds towards more beneficial services, potentially improving overall care quality for dual eligibles. However, the policy requires careful management and effective state-level implementation to realize these benefits.
Simulated Interviews
Retired (Buffalo, NY)
Age: 78 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 14/20
Statement of Opinion:
- I hope this policy makes it easier for me to keep up with all my medications and doctors.
- If they can make the paperwork less confusing, that would be a blessing.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 5 | 3 |
| Year 10 | 4 | 2 |
| Year 20 | 3 | 2 |
Retired Farmer (Rural Kansas)
Age: 65 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 5.0 years
Commonness: 10/20
Statement of Opinion:
- Rehabilitation is hard to get to out here. Any improvement would be welcome.
- If this policy means better transportation services for my therapy, that would help a lot.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 6 | 3 |
| Year 5 | 5 | 2 |
| Year 10 | 4 | 2 |
| Year 20 | 3 | 2 |
Unemployed (Los Angeles, CA)
Age: 50 | Gender: other
Wellbeing Before Policy: 2
Duration of Impact: 3.0 years
Commonness: 15/20
Statement of Opinion:
- Accessing mental health care has been a nightmare.
- If the policy helps coordinate care between my therapists and my doctors, that would be great.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 3 | 2 |
| Year 2 | 4 | 2 |
| Year 3 | 4 | 2 |
| Year 5 | 3 | 2 |
| Year 10 | 3 | 2 |
| Year 20 | 3 | 2 |
Part-time retail (Chicago, IL)
Age: 43 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 2.0 years
Commonness: 18/20
Statement of Opinion:
- I juggle work and hospital visits constantly.
- This could make managing appointments smoother if it really improves coordination.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 5 |
| Year 3 | 5 | 5 |
| Year 5 | 5 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 4 |
Retired School Teacher (Miami, FL)
Age: 85 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 4.0 years
Commonness: 12/20
Statement of Opinion:
- There's always something unexpected with my healthcare costs.
- Any additional support, especially financial, would help my family a lot.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 7 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 4 |
| Year 20 | 4 | 3 |
Retired musician (Austin, TX)
Age: 70 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 2.0 years
Commonness: 14/20
Statement of Opinion:
- I sometimes feel lost with how often staff changes.
- Stability in my care would make a world of difference.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 5 | 4 |
| Year 3 | 4 | 4 |
| Year 5 | 4 | 3 |
| Year 10 | 3 | 3 |
| Year 20 | 3 | 2 |
Unemployed (Seattle, WA)
Age: 62 | Gender: male
Wellbeing Before Policy: 3
Duration of Impact: 5.0 years
Commonness: 11/20
Statement of Opinion:
- Navigating benefits is tough for guys like me.
- I hope someone helps us at the VA with this policy.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 5 | 3 |
| Year 3 | 5 | 3 |
| Year 5 | 5 | 3 |
| Year 10 | 4 | 2 |
| Year 20 | 3 | 2 |
Homemaker (Boston, MA)
Age: 59 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 13/20
Statement of Opinion:
- Better syncing of my appointments with my own care duties would relieve stress.
- I hope this means I don't have to constantly chase after records.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 5 | 3 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 3 |
Retired Engineer (Phoenix, AZ)
Age: 82 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 2.0 years
Commonness: 16/20
Statement of Opinion:
- I've managed okay with what's been set up through Medicare Advantage.
- I remain skeptical about how much this policy will change for me.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 6 | 5 |
| Year 10 | 5 | 5 |
| Year 20 | 4 | 4 |
Retired Nurse (Atlanta, GA)
Age: 81 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 9/20
Statement of Opinion:
- Improvements to home care services would be wonderful.
- I hope they're serious about sending the right aides.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 5 | 3 |
| Year 10 | 5 | 3 |
| Year 20 | 4 | 3 |
Cost Estimates
Year 1: $250000000 (Low: $200000000, High: $300000000)
Year 2: $255000000 (Low: $204000000, High: $306000000)
Year 3: $260000000 (Low: $208000000, High: $312000000)
Year 5: $270000000 (Low: $216000000, High: $324000000)
Year 10: $285000000 (Low: $228000000, High: $342000000)
Year 100: $450000000 (Low: $360000000, High: $540000000)
Key Considerations
- The quality of care for dual eligibles is a significant consideration given their vulnerable status.
- Efficient allocation and use of funds are critical to minimize administrative burdens and maximize benefits for the target population.
- The policy's impact is contingent upon how well states implement integrated care solutions and administrative changes.
- Addressing improper payments in Medicaid is complex and may require collaboration with various stakeholders.