Virginia Hopes to Simplify Process for Dual Enrollees

Several organizations are still advocating for Virginia lawmakers to expand Medicaid within the Commonwealth. Opponents have argued that it is already too costly, is the largest single item in the state budget, and is in need of many reforms. But as Virginia Public Radio’s Tommie McNeil reports, the Department of Medical Assistance Services says it is addressing one major expense-by simplifying the process for providing care to those who receive both Medicaid and Medicare. . .


Some estimates indicate that one-third of Medicaid patients who need the most care comprise more than two-thirds of the cost of the program. Their services are provided with a mixture of Medicaid and Medicare funds.  As Karen Kimsey with DMAS explains, Medicare doesn't cover many services, so where it falls short, Medicaid steps in.  But it’s confusing and redundant for the dual enrollee who must navigate through all of the benefit packages and providers. However, because Virginia is a managed-care state, it has an opportunity to create one entity to coordinate all services:
Virginia is one of six states enrolled in the demonstration. It targets specific regions and as a result, only 78-thousand of the 100-thousand dual enrollees can benefit from it.