Bill Overview
Title: Supporting States in Integrating Care Act of 2022
Description: This bill requires state Medicaid programs to integrate and coordinate Medicaid and Medicare coverage for individuals who are dually eligible for both, including with respect to enrollment, quality measures, and access to care. The bill provides funds for FY2023 for planning grants and related implementation.
Sponsors: Sen. Casey, Robert P., Jr. [D-PA]
Target Audience
Population: Individuals who are dually eligible for Medicaid and Medicare
Estimated Size: 12000000
- The bill targets individuals who are dually eligible for both Medicaid and Medicare.
- Dual eligibility generally refers to low-income seniors and individuals with disabilities.
- There are approximately 12 million individuals who are dually eligible for Medicaid and Medicare in the United States.
- The integration aims to improve coordination of care, which should affect their access to healthcare services and quality of care.
- Given the nature of Medicare and Medicaid, the population mostly includes older adults, those with disabilities, and those who require long-term care, often with complex health needs.
Reasoning
- The primary population targeted by the policy are individuals who are dually eligible for Medicaid and Medicare, which include low-income seniors and individuals with disabilities.
- This group often requires complex care coordination due to multiple chronic conditions and long-term care needs.
- The impact of the policy will vary based on how effectively states implement integrated care models and utilize the provided planning grants.
- Some individuals may not experience immediate changes, while others could see significant improvements in care access and coordination, affecting their wellbeing scores substantially.
- Considering budget limits, states may need to phase implementation to ensure long-term sustainability.
Simulated Interviews
Retired (Rural Tennessee)
Age: 72 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- I hope this policy helps me see the same doctor for all my needs.
- It'd be great if I didn't have to fill out so many forms every time.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 8 | 5 |
| Year 10 | 8 | 5 |
| Year 20 | 8 | 5 |
Retired Engineer (New York City)
Age: 85 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 7/20
Statement of Opinion:
- Integration should make my healthcare more manageable.
- I hope my care providers communicate better.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 6 | 4 |
| Year 5 | 6 | 4 |
| Year 10 | 5 | 4 |
| Year 20 | 5 | 4 |
Retired School Teacher (Miami, Florida)
Age: 68 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 8.0 years
Commonness: 6/20
Statement of Opinion:
- My main concern is the high cost of medications.
- If this helps with prescription costs, I'll be relieved.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 6 | 6 |
| Year 20 | 5 | 5 |
Disabled Veteran (Austin, Texas)
Age: 59 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- I often feel like I fall through the cracks between systems.
- This could help me get the mental health support I need.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 5 |
Retired Nurse (Seattle, Washington)
Age: 75 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 2.0 years
Commonness: 6/20
Statement of Opinion:
- I am hopeful this means less paperwork and better assistance.
- I want to ensure my spouse receives the best possible care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 6 | 6 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 5 |
Freelance Writer (San Francisco, California)
Age: 64 | Gender: other
Wellbeing Before Policy: 7
Duration of Impact: 7.0 years
Commonness: 3/20
Statement of Opinion:
- I hope the policy improves specialized services for people like me.
- Integration should mean less discrimination in healthcare access.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 7 | 7 |
| Year 10 | 7 | 6 |
| Year 20 | 6 | 6 |
Retired Factory Worker (Chicago, Illinois)
Age: 78 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 5/20
Statement of Opinion:
- I don't have high hopes, but anything is better than endless waits.
- If this means I get treatments faster, I'll be grateful.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 5 | 4 |
| Year 3 | 5 | 4 |
| Year 5 | 5 | 4 |
| Year 10 | 4 | 4 |
| Year 20 | 4 | 4 |
Retired Chef (Phoenix, Arizona)
Age: 66 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- Rehab access is crucial for my recovery now.
- Healthcare integration could cut down wait times.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Retired Carpenter (Boise, Idaho)
Age: 71 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 7.0 years
Commonness: 4/20
Statement of Opinion:
- Preventing another stroke is my top priority.
- Streamlined care could help me access therapies more easily.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
Retired (Detroit, Michigan)
Age: 82 | Gender: female
Wellbeing Before Policy: 3
Duration of Impact: 5.0 years
Commonness: 5/20
Statement of Opinion:
- This policy might ease my family's burden.
- I just hope it leads to better emergency care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 4 | 3 |
| Year 2 | 4 | 3 |
| Year 3 | 4 | 3 |
| Year 5 | 3 | 3 |
| Year 10 | 3 | 3 |
| Year 20 | 3 | 3 |
Cost Estimates
Year 1: $5000000000 (Low: $4000000000, High: $6000000000)
Year 2: $4500000000 (Low: $3500000000, High: $5500000000)
Year 3: $4000000000 (Low: $3000000000, High: $5000000000)
Year 5: $3500000000 (Low: $2500000000, High: $4500000000)
Year 10: $3000000000 (Low: $2000000000, High: $4000000000)
Year 100: $1000000000 (Low: $500000000, High: $1500000000)
Key Considerations
- Integration requires substantial state-level administrative overhaul and technology improvements.
- Potential for cost savings through reduced duplication of services and improved care coordination.
- Risks associated with initial implementation delays or mismanagement could inflate costs.
- Impact on healthcare providers and systems as they adapt to new standards and processes.