By Carten Cordell Watchdog.org Virginia Bureau
ALEXANDRIA— Even if they agree that American health care needs 100cc’s of urgent attention, Obamacare’s critics think the president’s prescription is worse than the disease. Take for instance just one part of the Affordable Care Act, the Financial Alignment Initiative.
Never heard of it? Here’s what you need to know: It’s an ambitious federal pilot program enlisting 26 states, countless government agencies and medical interests in a search for solutions to a health care challenge few know exists, the problem of so-called “dual eligibles.”
And so far, almost everybody hates it.
While many agree the dual eligible issue demands immediate attention, the Financial Alignment Initiative has become a public piñata that agencies have pummeled for being unwieldy, over broad and unclear — a disaster.
Dual eligibles are often poor, disabled or elderly residents whose health care needs are so great that they qualify for both Medicare and Medicaid. More than half of dual eligibles earn less than $10,000 a year and have three or more chronic conditions. Sixty percent have cognitive problems.
The Kaiser Commission on Medicaid and the Uninsured estimates there are 9 million dual eligibles nationwide, and while they account only for 15 percent of the Medicaid and 21 percent of the Medicare population, their health care bills comprise 39 percent and 36 percent of the entitlement programs’ expenditures.
To discover which program will pick up the tab for dual eligibles’ medical care — and how they’ll pick it up — is a lesson in bureaucratic entanglement.
To cut through the red tape, the Affordable Care Act created The Federal Coordinated Health Care Office, a division of the Centers for Medicare & Medicaid Services (CMS), exclusively to find and implement cost-effective solutions for dual eligible-care.
Its answer was the Financial Alignment Initiative, a three-year test of two cost-sharing plans between states, managed care organizations (MCOs) and the federal government.
The initiative also encourages the states by dangling the prospect of Medicare and Medicaid savings through fully integrated care.
States would submit proposals on how they would implement each of the spending plans. Public comment sessions on the plans would ensue, followed by evaluation periods. May the best plan win.
Then all hell broke loose.
Twenty-six states have submitted proposals for 15 slots. Virginia is one of the hopefuls, looking to test one of the two health care plans on about half of its 110,000 dual eligibles.
The federal program is supposed to test the programs with a total of 1 to 2 million dual eligibles. Some fear that enrollment may stretch to 3 to 7 million if some states enroll their entire dual-eligible population. And some, like the Medicare Payment Advisory Commission (MedPAC), worry that the programs — whether they really work or fail miserably — will generate their own constituencies and will become an established health care option for states.
In a July 10 letter, Sen. Jay Rockefeller, D-West Virginia, urged Health and Human Services Secretary Kathleen Sebelius “to take immediate steps to halt this initiative as currently structured and to take the time necessary to develop a well-designed and thoroughly evaluate care coordination model for dual eligibles.”
Under Virginia’s proposal, managed care organizations will be responsible for delivery and coordination of services provided by Medicaid and Medicare. Like all other proposals, that plan has critics, including the Virginia Health Care Association. In this case, critics say plan gives managed care organizations too much power. VHCA, which licenses nursing homes and assisted living centers throughout the state, expressed concern about the care the pilot program would provide to nursing home residents, with an estimated 60 percent of the state’s facilities affected by the state’s plan.
“The Demonstration proposal appears to simply leave the vast majority of Medicare and Medicaid payment decisions in the hands of Managed Care Organizations who have demonstrated very little long-term ability to successfully manage the care for dual eligible populations,” VHCA president Stephen Morrisette wrote in a May 11 letter to Department of Medical Assistance Services director Cynthia Jones.
Despite the criticism, the Financial Alignment Initiative seems to be moving forward. CMS spokeswoman Michelle Saghafi said improving the care of dual eligibles has been a complex problem and that the questions raised are being considered.
“Given the diversity and significant health care needs of dual eligibles, we recognize how critical it is to have beneficiary protections in place to achieve the highest-quality health care possible,” she said in an email. “We are taking the input from Congress, MedPAC, and others very seriously moving forward.”