PUP 4931r Lecture Notes - Lecture 74: Long-Term Care, Aid To Families With Dependent Children, Managed Care
16 May 2018
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Dual Eligibles
Dual Eligibles are a Very Expensive Subgroup of Medicaid Enrollees
Who Are Dual Eligibles
Medicare beneficiaries also eligible for some level of assistance from state
Medicaid.
Minimum is Medicaid pays for Medicare’s preius ad cost-sharing
Maximum can be all services not offered by Medicare but ones state has included
in its state plan
e.g., ng-term care and at state option, hearing, vision, dental services.
Medicaid Fills the Significant Gaps in Medicare’s Coverage for Dual Eligibles
Medicaid pays the Medicare Part B premium ($104/month) and cost sharing
charged for many Medicare services
Medicaid covers benefits not covered by Medicare
Long term care, including nursing homes
Dental
Vision
Dual Enrollees are Poorer and Sicker Than Other Medicare Beneficiaries
States are pushing as many people as possible into managed care to try to control
spending and make it more predictable
Florida is going at it in a big way - statewide
Current Status
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Dual eligibles are a very expensive subgroup of medicaid enrollees. Medicare beneficiaries also eligible for some level of assistance from state. Minimum is medicaid pays for medicare"s pre(cid:373)iu(cid:373)s a(cid:374)d cost-sharing. Maximum can be all services not offered by medicare but ones state has included in its state plan e. g. , ng-term care and at state option, hearing, vision, dental services. Medicaid fills the significant gaps in medicare"s coverage for dual eligibles. Medicaid pays the medicare part b premium (/month) and cost sharing charged for many medicare services. Dual enrollees are poorer and sicker than other medicare beneficiaries. States are pushing as many people as possible into managed care to try to control spending and make it more predictable. Florida is going at it in a big way - statewide. 2/3rds of nursing home patients; 70% of beds. Pptx: national cost went from 2. 4 billion in 1970 to 87. 4 billion in 1996. Program costs necessarily increase when eligible individuals increase (entitlement. )
