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National Coalition On Health Care

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Medicare at Risk? Exploring the Implications of Medicaid Per Capita Caps for Medicare and Its Beneficiaries

June 15, 2017 By National Coalition on Health Care

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FACT SHEET

 

Key Insights
  • 1 in 5 Medicare beneficiaries also rely on Medicaid. These 11 million enrollees tend to have more complex care needs and account for greater expenditures than the average Medicare beneficiary. They are often referred to as dually eligible beneficiaries.
  • State Medicaid programs are now investing in significant reforms of care for this dually eligible population, focused on substituting improved care coordination and less-intensive, more person-centered interventions, including home- and community-based services (HCBS), for the major expenses associated with future, downstream hospital and specialty care.
  • Medicaid per capita cap legislation would result in a gap between each state’s statutorily determined capped amount and the changing cost of care—generating greater overall budget pressure on state Medicaid programs.
  • Under this pressure, states would have an incentive to roll back their ongoing investments in these Medicaid reform initiatives—shifting costs and utilization back toward the Medicare programs’ hospital and post-acute benefits

Filed Under: Fact Sheets & Issue Briefs, Preserving and Improving Medicaid and CHIP

Mission

To bring together key stakeholders in order to achieve an affordable, high-value health care system for patients and consumers, for employers and other payers, and for taxpayers.

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National Coalition on Health Care

About Us

The National Coalition on Health Care (NCHC) was formed more than two decades ago to help achieve comprehensive health system change and is currently led by John Rother. We aim to be a leader in promoting a healthy population and a more effective, efficient and responsive health system that provides quality care for all. NCHC is a nonpartisan, nonprofit organization of organizations. Our growing Coalition represents more than 80 participating organizations, including medical societies, businesses, unions, health care providers, faith-based associations, pension and health funds, insurers, and groups representing consumers, patients, women, … Read More...

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John Rother

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Shawn Martin

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Jack Lewin
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Lewin and Associates, LLC

MISSION

To bring together key stakeholders in order to achieve an affordable, high-value health care system for patients and consumers, for employers and other payers, and for taxpayers.

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