In Their Own Words

Bipartisan Support Grows To Solve One of Health Care’s Biggest Problems

Dually Eligible Americans on Medicare and Medicaid Are Getting the Attention They Deserve

May 9, 2024

By:

Rachel M. Werner, MD, PhD

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The following excerpt is from an op-ed that first appeared in The Hill on May 9th, 2024.

To appreciate one of the great snafus of American health care, consider the plight of people who are poor, elderly — often with a disability — and insured by both Medicare and Medicaid.  

One might think having two insurers must be better than one. But these two programs were never meant to work together. Rather than cooperating, the programs follow rules that create incentives for each partner to shift costs to the other, while patients are stuck in the middle, without the care they need. 

For dually eligible Americans, bureaucratic nightmares are their daily realities. 

A woman in her mid-30s with spina bifida relied on her electric wheelchair to get around. But when it failed in the middle of a busy New York City street, Medicaid required that she first ask Medicare to replace the wheelchair, knowing full well that the program wouldn’t cover it. It was only once Medicare denied the request that Medicaid began to consider her pleas for a replacement. The whole process took 20 months — so long that she resorted to a makeshift chair that left her with pressure sores and back aches.

In another case, an older man lost his dentures when coverage problems caused him to switch rehab centers multiple times, forcing him to eat only soft foods for years while Medicare and Medicaid refused to pay for replacements.

And a woman with a stroke struggled to receive needed rehabilitation while getting threatened with massive Medicare copays that Medicaid should cover. Then she was told she would lose her Medicaid coverage unless she produced five years of income documentation and re-registered within 13 days. Even her niece, a former top policy strategist at the Center for Medicare and Medicaid Innovation – the Centers for Medicare & Medicaid Services regulator – was stymied by the maze of requirements. If CMS’s top leaders struggle to navigate the system, who can?

These accounts are emblematic of the problems that plague the nearly 13 million dually eligible individuals with disabilities or are old enough to qualify for Medicare and poor enough to get Medicaid. Nearly all make less than $20,000 a year. They are arguably sicker than any other group enrolled in Medicare or Medicaid, with lifespans that are a decade shorter than other patients. And they cost the government a cool half a trillion dollars a year — a sum greater than any other group and one that will surely rise as the country ages.

Read the entire op-ed here.