Pros And Cons Of Medicaid

In 2014, there were 9.9 million people who are dual eligible (Medpac, 2016). Out of them, 7.1 million were eligible for full benefit and 2.8 million were for partial benefit. Dual eligible beneficiaries include seniors and non-elderly people with significant disabilities, accounting for disproportionate share of spending in both programs. Medicare patients require higher use of medical services such as hospital care, home health care, physician services, durable medical equipment, and prescription drugs. While Medicaid patients have relatively high spending attributed to their need for long term support services (LTSS), such as nursing home care or community based care.

The Center for Medicare and Medicaid Innovation has launched new the

Gives states the opportunity to access shared savings. Offers significant opportunities to fully integrate administrative process including marketing, member materials, appeals, and quality measurements. Facilitates sharing of both Medicare and Medicaid encounter data with states.

Cons: Medicare-Medicaid Plans in the demonstrations may still solo responsibilities for dually eligible beneficiaries in different parts of their organizations. MMP plans may not reimburse providers in a wat that incentivizes care coordination or effective transitions in care. Under capitation, insurers may have a financial incentive to limit both unnecessary and necessary care in order to retain a larger portion of their capitation payment.

Pros and cons of traditional FFS:

Managed FFS retains the freedom of choice that is hallmark of traditional Medicare and Medicaid. Since FFS model does not shift financial risk onto a third party, the model in general envision a more targeted selection of beneficiaries, which allows concentration of resources on those most at risk of health crises and higher costs. Managed FFS could be an attractive option where establishing HMO-like managed care networks is difficult, like rural

Recent beneficiary surveys from Virginia suggest that the long-term viability of the program depends on attracting and keeping beneficiaries enrolled (Summer & Hoadley, 2015). However, Stakeholders identified that beneficiaries were likely to opt-out or dis-enroll from the demonstration due to satisfaction with existing care, lack of information regarding the demonstration, and resistance from providers. Plans noted that they are often unable to locate enrollees to send enrollment information or conduct health risk assessments (Rollins,