Panelists Urge Better Efforts to Serve 'Partial Dual Eligibles'

by Leslie Small

In the world of government-sponsored health plans the "hidden population" of partial dual eligibles is long overdue for increased attention from both payers and policymakers, panelists said during a recent session at AHIP’s virtual Medicare, Medicaid and Dual-Eligibles conference.

Partial dual eligibles are individuals whose incomes are low enough to qualify for financial assistance from state Medicaid programs to help them pay Medicare cost sharing and premiums but not quite low enough to count them as full dual eligibles. That means they cannot receive Medicaid benefits such as behavioral health services and long-term services and supports (LTSS).

Research conducted by the firm ATI Advisory into this population found "pretty consistent trends" among partial dual eligibles across the country in terms of their characteristics and their needs, said panelist Allison Rizer, principal of the consultancy. Like full duals, partial duals are more likely than Medicare-only beneficiaries to be Black or Hispanic, lacking internet access at home and experiencing food insecurity, among other findings.

SCAN aims to address 'near duals':

• "We treat dual status/partial dual status as a health equity issue, and we are trying to use our data to look for the inequities that exist," said panelist Eve Gelb, senior vice president of healthcare services at SCAN Health Plan.
• SCAN is hoping to address unmet needs in what Gelb calls "near duals," a blanket term that includes partial dual eligibles as well as Medicare beneficiaries who are just above the federal poverty level — making them ineligible for any type of Medicaid benefits.
• SCAN's goal, Gelb explained, is to "target beneficiaries with income between 100% and 150% of the federal poverty level with two or more deficits in their [ability to complete] activities of daily living. You provide these folks with limited long-term services and supports" to reduce things like hospital admissions and nursing home placement.

A call for more awareness:

• Regarding the barriers that stand in the way of addressing partial dual eligibles' needs, Rizer identified awareness as one major issue. "There really is a lack of understanding of who the partial duals population is," she said.
• The policy conversation around Medicare-Medicaid benefits integration also inadvertently results in "partial duals getting kicked to the side," Rizer said.

From Health Plan Weekly