Individuals who are dually eligible for both Medicare and Medicaid make up a sizable portion of the overall home-based care population.
Too often, though, this dual status comes with frustrating challenges around care plans and coordination. Legislation introduced in the U.S. Senate on Thursday hopes to reduce some of those frustrations while also creating new opportunities for the Program of All-Inclusive Care for the Elderly (PACE) model.
The bipartisan bill – known as the Delivering United Access to Lifesaving Services (DUALS) Act of 2024 – was introduced by Sens. Bill Cassidy (R-La.), Tom Carper (D-Del.), John Cornyn (R-Texas), Mark Warner (D-Va.), Tim Scott (R-S.C.) and Bob Menendez (D-N.J.).
Several senior care groups have backed the legislation, including Welbe Health, the National PACE Association and PointClickCare, among others. LeadingAge has likewise endorsed the DUALS Act.
“The DUALS Act of 2024 addresses some of the challenges and opportunities facing America as our population ages,” Katie Smith Sloan, president and CEO of LeadingAge, said in a statement shared with Home Health Care News. “For too many older adults, particularly those with low incomes and multiple, chronic health conditions, accessing care and services through Medicare and Medicaid is a fraught endeavor that ends in frustration and – worse yet – inadequate results.”
More than 12 million individuals are currently considered “dual eligibles,” or “duals,” according to a brief on the newly introduced legislation.
In Medicare, duals make up about 19% of all enrollment, but they account for 34% of total spending. In Medicaid, duals account 30% of spending and 14% of enrollment.
Among its provisions, the DUALS Act would require each state to select, develop and implement a comprehensive, integrated health plan for dual-eligible beneficiaries, building off of existing coverage options or creating a new system entirely. These efforts would come with support from the U.S. Centers for Medicare & Medicaid Services (CMS).
The bill also seeks to require plans to develop and update care coordination plans while establishing a care coordinator for each dual-eligible beneficiary.
Compared to the broader Medicare population, there is a greater share of dual-eligible individuals in home health care. That’s true for both fee-for-service and Medicare Advantage (MA), according to the Research Institute for Home Care.
As of 2021, more than 22% of fee-for-service home health users were duals. Meanwhile, more than 30% of MA home health users were duals.
“This legislation is a start at redesigning our current patchwork approach of delivering long-term services and supports,” Sloan continued.
As for the PACE model, the DUALS Act would take the major step of requiring every state to allow for the establishment of PACE programs. Red tape and restrictions in many states has been a roadblock to PACE expansion for years, despite several studies and statistics demonstrating the cost-savings ability and effectiveness of the model.
The legislation would also allow individuals to enroll in PACE at any point in time and expand PACE eligibility to those under the age of 55.
Currently, there are only 156 PACE organizations operating in 32 states and the District of Columbia.
“The National PACE Association applauds the visionary leadership demonstrated in seeking to increase care integration for individuals covered by both Medicare and Medicaid, which will improve both their health status and quality of life,” Shawn Bloom, president and CEO of the organization, told HHCN in an email. “NPA in particular commends the embrace of the critical role that [PACE] will have in achieving those aims for older adults and those living with disabilities.”
The DUALS Act faces an uphill battle in Congress, and Sen. Cassidy acknowledged in a conversation with health policy podcast Tradeoffs that the bill faces difficult odds of passing this session.
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