Bill Overview
Title: Comprehensive Care for Dual Eligible Individuals Act
Description: This bill provides states with the option to establish a separate health care program for individuals who are dually eligible for Medicare and Medicaid. Programs must provide a core package of covered benefits to address the individualized medical, behavioral, long-term care, and social needs of enrollees, including all basic Medicare and Medicaid benefits. States may receive federal matching payments in accordance with a specified formula; the bill provides funds for the Federal Coordinated Health Care Office to implement the bill.
Sponsors: Sen. Brown, Sherrod [D-OH]
Target Audience
Population: dual eligible individuals (Medicare and Medicaid)
Estimated Size: 12000000
- Dual eligible individuals are those who qualify for both Medicare and Medicaid due to low income, age, and/or disability, representing a vulnerable group with complex health care needs.
- In the United States, approximately 12 million people are considered dual eligible individuals.
- Globally, estimates for similar groups may consider countries with similar healthcare systems and social safety nets, but most countries do not have both Medicaid and Medicare-like programs, restricting direct global parallel.
- The impact of providing integrated care specifically tailored to dual eligible individuals aims to improve health outcomes while also managing costs.
Reasoning
- The target population for this policy is dual-eligible individuals, about 12 million people in the U.S. These individuals qualify for both Medicare due to age or disability and Medicaid due to low income, making them a vulnerable group with complex needs.
- The policy's impact is expected to be substantial for those served by programs established under the bill, potentially improving healthcare coordination and reducing costs through a more integrated approach.
- Since dual eligible individuals are a distinct group due to federal and state healthcare policies, the specific U.S. components are crucial for assessing the population.
- Given the budget constraints and projected size of the program, only a fraction of the dual eligible population could be served initially, with expectations of scaling over time.
Simulated Interviews
retired teacher (Florida)
Age: 72 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- This policy could make my health care more streamlined. Right now, I feel like I have to navigate through different systems that don’t talk to each other.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 9 | 6 |
| Year 10 | 9 | 5 |
| Year 20 | 8 | 4 |
retired factory worker (Ohio)
Age: 63 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 7.0 years
Commonness: 9/20
Statement of Opinion:
- If this policy really improves care coordination, it would be a big relief for folks like me who are on dozens of medications.
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 | 7 | 4 |
| Year 20 | 6 | 4 |
unemployed (Texas)
Age: 45 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 3.0 years
Commonness: 5/20
Statement of Opinion:
- I'm skeptical this will reach me personally, even though it sounds like it could help with my mental health care.
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 | 3 |
| Year 20 | 5 | 3 |
retired nurse (New York)
Age: 81 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 5.0 years
Commonness: 4/20
Statement of Opinion:
- Being in and out of hospitals is exhausting, so anything that makes that simpler would be appreciated.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 7 | 3 |
| Year 5 | 7 | 3 |
| Year 10 | 6 | 2 |
| Year 20 | 5 | 2 |
part-time worker (California)
Age: 55 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 7.0 years
Commonness: 7/20
Statement of Opinion:
- I hope this policy could help people like me better understand what we're entitled to. It's often confusing.
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 | 7 | 4 |
| Year 20 | 6 | 3 |
retired (Illinois)
Age: 76 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 8.0 years
Commonness: 6/20
Statement of Opinion:
- The policy offers hope for more cohesive care. It could potentially mean fewer conflicts between my care providers.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 8 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 9 | 4 |
| Year 10 | 8 | 3 |
| Year 20 | 7 | 3 |
retired truck driver (Missouri)
Age: 68 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 6.0 years
Commonness: 7/20
Statement of Opinion:
- I'd support the policy if it actually lowers the costs of my prescriptions.
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 | 5 |
| Year 10 | 8 | 4 |
| Year 20 | 7 | 3 |
retired engineer (Massachusetts)
Age: 70 | Gender: other
Wellbeing Before Policy: 5
Duration of Impact: 4.0 years
Commonness: 3/20
Statement of Opinion:
- Inclusive policy implementation could be revolutionary for marginalized individuals like myself.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 4 |
| Year 10 | 5 | 3 |
| Year 20 | 5 | 3 |
part-time caregiver (Washington)
Age: 59 | Gender: female
Wellbeing Before Policy: 4
Duration of Impact: 6.0 years
Commonness: 6/20
Statement of Opinion:
- If the policy could reduce the stress of managing dual care setups, it would be a welcome change.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 7 | 3 |
| Year 10 | 6 | 3 |
| Year 20 | 5 | 2 |
retired farmer (Georgia)
Age: 78 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- Rural folks often get left out. Hopefully, this policy helps equalize access to good care.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 4 |
| Year 2 | 7 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 8 | 3 |
| Year 20 | 7 | 2 |
Cost Estimates
Year 1: $15000000000 (Low: $13000000000, High: $18000000000)
Year 2: $15500000000 (Low: $13500000000, High: $18500000000)
Year 3: $16000000000 (Low: $14000000000, High: $19000000000)
Year 5: $17000000000 (Low: $15000000000, High: $20000000000)
Year 10: $18000000000 (Low: $16000000000, High: $22000000000)
Year 100: $25000000000 (Low: $20000000000, High: $30000000000)
Key Considerations
- Dual eligible individuals represent a high-cost and vulnerable population group that would benefit from integrated care.
- The success of the program depends on effective coordination between federal, state, and local agencies, impacting administrative feasibility.
- Long-term savings from reduced hospitalizations and emergency care usage may offset initial program expenses.
- Monitoring and evaluating health outcomes and financial impacts will be crucial in adapting the program to meet its objectives.