GAO Report Finds Notable Differences Between Medicare and Medicaid Consumer Protections
House Ways and Means Ranking Member Sander Levin, Health Subcommittee Ranking Member Pete Stark, House Energy and Commerce Ranking Member Henry A. Waxman, Health Subcommittee Ranking Member Frank Pallone, Jr., and Senate Finance Committee Chairman Max Baucus and Health Subcommittee Chairman Jay Rockefeller yesterday unveiled a GAO report titled Medicare and Medicaid: Consumer Protection Requirements Affecting Dual-Eligible Beneficiaries Vary Across Programs, Payment Systems, and States, examining the consumer protections for individuals enrolled in Medicare and Medicaid, often referred to as dual eligible beneficiaries.
GAO compared consumer protection requirements in Medicare and Medicaid as well as the compliance and enforcement actions taken by CMS and selected states against managed care plans. GAO found notable differences in enrollment choice across programs as well as across states. While enrollment in the Medicare managed care program, Medicare Advantage, is voluntary, some states, through waivers from CMS, can require enrollment in Medicaid managed care. The report also found that Medicare and Medicaid have different requirements for beneficiaries to receive services through nursing facilities and home health care. Additionally, the appeals processes for the two programs do not align with each other. As CMS and states work together to integrate care for dual eligible beneficiaries, these differences must be addressed in order for beneficiaries to receive timely and appropriate care.
In examining compliance and enforcement, GAO found that both CMS and states used a range of actions to help ensure that managed care plans complied with consumer protections.
The GAO report can be accessed here.
“This report highlights the importance of strong patient protections for all beneficiaries in the Medicare and Medicaid programs and the unique situation of those enrolled in both,” said Representative Levin, Ranking Member of the House Ways and Means Committee. “This report informs on-going efforts to integrate care and financing for dual eligible beneficiaries but we must remember that consumer protections are paramount in these programs.”
“GAO’s report highlights the wide variation of consumer protection standards affecting dual eligible beneficiaries across Medicare and Medicaid. As many states move forward with initiatives to further integrate care for this population, this report makes clear how important it will be to ensure that beneficiaries aren't losing access to consumer protections because of this variation,” said Representative Stark, Ranking Democrat, Ways and Means Health Subcommittee.
“As we continue building upon the framework in the Affordable Care Act to improve care for those who receive benefits from both Medicare and Medicaid, GAO’s work highlights areas where we can turn our attention for protecting patients. For this vulnerable population, strong protections are critical,” said Representative Waxman, Ranking Member of the House Committee on Energy and Commerce.
“Beneficiaries enrolled in both the Medicare and Medicaid programs are a unique population with specific needs,” said Representative Pallone, Ranking Democrat on the House Energy and Commerce Health Subcommittee. “If we are going to build on the reforms of the Affordable Care Act and strengthen the way in which we provide these beneficiaries care, then we must ensure that consumer protections are aligned in both programs. GAO’s work helps inform those efforts.”
“Patients enrolled in both Medicare and Medicaid are vulnerable and often require costly care,” Senator Baucus, Chairman of the Senate Finance Committee, said. “We need to keep up our efforts to make sure our federal health programs work better to lower costs and protect patients’ rights. We made progress in health reform coordinating between Medicare and Medicaid, and there’s more for us to do.”
“I continue to be very concerned with the Administration’s efforts to move Americans who are eligible for both Medicare and Medicaid into Medicaid managed care plans,” said Senator Rockefeller, Chairman of the Senate Finance Health Subcommittee. “This report reinforces the need to focus on the best ways to provide care to these patients, including essential consumer protection requirements, which vary dramatically across state and health programs. This report makes clear that we still have a lot of work to do to determine the best path forward to effectively provide care for these patients.”