“A True Win” Industry Comments on DUALS Act of 2024

WASHINGTON—U.S. Senators Bill Cassidy, M.D. (R-LA), Tom Carper (D-DE), John Cornyn (R-TX), Mark Warner (D-VA), Tim Scott (R-SC) and Bob Menendez (D-NJ), members of the Senate Duals Working Group, introduced the Delivering Unified Access to Lifesaving Services (DUALS) Act of 2024 to improve coverage for individuals jointly enrolled in Medicare and Medicaid, also known as dual eligibles.

The DUALS Act of 2024:

• Requires each state, with support from the Centers for Medicare & Medicaid Services (CMS), to select, develop and implement a comprehensive, integrated health plan for dual-eligible beneficiaries. States can create a new system or build off of existing coverage options.
• Improves beneficiary experience by requiring plans to develop and update care coordination plans, requiring the establishment of ombudsman offices, and establishing a care coordinator for each beneficiary.
• Reduces beneficiary confusion by reducing “look-alike” plans which target dual eligible beneficiaries for enrollment but don’t provide any coordination, creates a single appeals process instead of the current Medicare and Medicaid appeals process, and reduces third-party marketing organization incentives to target beneficiaries.
• Expands Program of All-Inclusive Care for the Elderly (PACE) coverage nationwide by requiring every state to allow PACE programs to be established, allows enrollment in a PACE program at any time in the month, and expands PACE coverage to individuals under the age of 55.

“Patients dually eligible for Medicare and Medicaid have much worse outcomes than other groups even though there is a lot more money spent on their care,” said Cassidy. “Making Medicare and Medicaid better work together makes patients healthier and saves money for taxpayers.”

“Beneficiaries who are dually eligible for Medicare and Medicaid are often the sickest and most vulnerable patients in our country, and, particularly for these patients, we must reduce the unnecessarily complex nature of health care in America,” said Carper. “This bipartisan bill directly works to simplify complexities for the millions of dual eligible Americans in need, while simultaneously reducing bureaucratic headaches for the government, health care providers, and patients alike. We’ve worked hard over the last three years to draft this legislation, and I’m proud to introduce the product of our years of work today.”

“Medicare and Medicaid oftentimes don’t coordinate care for individuals enrolled in both programs, which can lead to poor outcomes for patients and inefficient spending for our health care system,” said Cornyn. “By requiring states to develop an integrated health plan for these Americans, this legislation would help streamline the system, improve beneficiary experience, and ensure taxpayer dollars are spent responsibly.”

“This bill is the result of a year of work and input from stakeholders across the country,” said Warner. “It responds directly to what we heard and what we’ve known for a while, which is that the status quo isn’t working. This bill will help make sure that duals have access to improved, integrated care, and that states receive additional resources so that they can more fully support this vulnerable population.”

“Many states lack fully integrated care between Medicare and Medicaid, leaving dually eligible individuals with fragmented care and the headaches of confusing bureaucracy. We can, and must, do better for this vulnerable population,” said Scott. “Our bill will help ensure these programs work together so that patients across the nation can access the high-quality care they deserve.”

“The DUALS Act of 2024 addresses some of the challenges and opportunities facing America as our population ages,” Katie Smith Sloan, president and CEO of LeadingAge, the association of nonprofit providers of aging services. “For too many older adults, particularly those with low incomes and multiple, chronic health conditions, accessing care and services through Medicare and Medicaid is a fraught endeavor that ends in frustration and, worse yet, inadequate results. This legislation is a start at redesigning our current patchwork approach of delivering long-term services and supports. It incorporates many elements we proposed back in 2017 to ensure that dual eligibles can access the supports they need—including the creation of comprehensive care plans and interdisciplinary care teams and a single pooled payment—and more. This is a true win, and we applaud Senators Cassidy, Carper, Cornyn, Warner, Scott and Menendez for their far-sighted, fulsome support of this bill. More than 12 million low-income or disabled people in the U.S. who currently qualify as dual eligibles will benefit today—and many more will follow, as our country’s massive population shift continues.”  

The DUALS Act of 2024 is supported by Centerlight Healthcare, Santa Clara Family Health Plan, Association for Community Affiliated Plans (ACAP), PointClickCare, Welbe Health, American Kidney Fund, National Multiple Sclerosis Society, Alliance of Community Health Plans, LeadingAge, Bipartisan Policy Center, National Health Council, ChristianaCare, DaVita, and National Pace Association.

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