Ohio Gets Federal Approval for Dual-Eligible Coverage Project

   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 [e-mail]

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