By Jon Kamp
The state of Ohio said Wednesday it has secured federal approval
for a new program that will start covering about 114,000 high-cost
patients who qualify for both Medicare and Medicaid in a more
coordinated fashion next year.
The state said voluntary enrollment in the demonstration program
for so-called dual-eligible patients will begin Sept. 1, which is
pushed back several months from an earlier target. Still, Ohio
remains among the early movers as states around the country work
with the federal government to streamline care for these
patients.
This summer, Ohio selected a handful of insurers, including
Aetna Inc. (AET), Molina Healthcare Inc. (MOH) and Centene Corp.
(CNC), to divide up coverage of these high-cost patients. The state
also picked UnitedHealth Group Inc. (UNH) and an alliance between
Humana Inc. (HUM) and the nonprofit health plan CareSource.
Despite qualifying for two government health programs due to age
or disability, plus lack of financial resources, dual patients can
face a confusing system with overlapping rules and poor
coordination. This can lead to diminished quality of care and poor
health outcomes that increase costs for taxpayers, according to
Ohio's press release.
The state noted its roughly 180,000 dual-eligible patients make
up just 14% of Medicaid enrollment, but about 40% of spending.
Overall, there are about nine million dual patients in the U.S. who
account for at least $300 billion in annual health-care
spending.
Ohio is one of about two dozen states aiming to test
ways--working with the federal government with some help from the
health-care overhaul law--to improve the system while restraining
costs. The federal government covers Medicare and shares Medicaid
costs with states.
Health insurers are jockeying for position to win business to
cover these patients, even though profit margins are expected to be
slim, and dual patients' often-complex medical problems will
challenge efforts to tamp down costs. Some patient advocates have
questioned whether the states and federal government are moving too
fast, arguing the theory that better coordination will cut costs
and improve care is untested.
The administration of Ohio Gov. John Kasich announced the
state's agreement for a three-year demonstration program with the
Centers for Medicare and Medicaid Services. Ohio is just the third
state to win approval for such a program after Massachusetts and
Washington.
Write to Jon Kamp at jon.kamp@dowjones.com
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