- http://www.kaiserhealthnews.org/stories/2012/december/06/medicare-medicaid-managed-care-experiment.aspx
- http://www.usatoday.com/story/news/nation/2012/12/05/medicare-medicaid-experiment-on-managed-care/1736115/
- http://www.kaiserhealthnews.org/Multimedia/2012/December/medi-cal-managed-care.aspx
List date(s) this work was published or aired.
12/5/2012
Provide a brief synopsis of the story or stories, including any significant findings.
We examined a large group of disabled Medicaid enrollees in California who were moved out of traditional fee-for-service health coverage into a managed care plan. Many of these enrollees are also expected to eventually qualify for Medicare, the federal health insurance program for the elderly and disabled. Federal officials have begun to roll out a similar, but larger effort required by the Affordable Care Act. That program will move up to 2 million of the nation’s sickest and most expensive patients — known a “dual eligibles” because they qualify for both Medicare and Medicaid — into managed care. We wanted to see what the California experience could mean for the national program. We found many problems with the California program, including patients having difficulty staying with the doctors who had treated them for long periods of time through difficult, complex illnesses and that patients found the appeals process onerous.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
We examined the findings of a report from the California HealthCare Foundation, as lawsuits filed by patients, congressional testimony and state proposals to move duals into managed care.
Explain types of human sources used.
Patients, caregivers, advocates, insurance company executives and federal and state officials.
Results:
Our story pointed to potential problems as the federal government oversees state proposals to move dual eligibles into managed care.
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No.
Advice to other journalists planning a similar story or project.
Writing about “duals” is complicated issue but an important one because they are some of the sickest and frailest people to provide medical care for. Their medical care costs a lot too, so in the broader debate about how to control health care costs how to care for this population is critical. Federal and state governments spend nearly $300 billion each year on the medical and home care needs of patients who are enrolled in both Medicaid and Medicare. They account for 31 percent of Medicare’s spending and 39 percent of Medicaid’s spending, according to the Centers for Medicare and Medicaid Services.