Press Release

Today, U.S. Representatives Ami Bera, M.D. (CA-06) and Mike Kelly (PA-16) 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.

Similar legislation has been introduced in the U.S. Senate by Sens. 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.

“Patients who are dually eligible for Medicare and Medicaid should not face poor health outcomes due to the bureaucratic patchwork of our health care system,” said Representative Ami Bera, M.D., who previously served as Chief Medical Officer for Sacramento. “This bill takes a critical step forward in ensuring that some of the most vulnerable Americans receive the integrated and quality care that they deserve. I am proud to stand with my colleagues in Congress in supporting these bipartisan efforts that prioritize the well-being of millions of Americans while saving taxpayers money.”

"We are always striving to find the best way possible to serve patient needs, improve patient outcomes, and ultimately strengthen Medicare and Medicaid programs," said Rep. Mike Kelly, a member of the Ways & Means Subcommittee on Health. "This legislation will improve coverage for Americans enrolled in both programs and will ultimately save taxpayer money."

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.

• 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.

BACKGROUND

Approximately 12.2 million low-income or disabled people in the United States are jointly enrolled in Medicare and Medicaid. Dual eligibles are a diverse group with a complex, unique set of needs. This population includes individuals with multiple chronic conditions, physical disabilities, mental illness, and cognitive impairments such as dementia and developmental disabilities, and others who are relatively healthy.

While representing a small proportion of Medicare and Medicaid beneficiaries, dual eligibles account for a disproportionate share of overall spending. In the Medicare program, 19% of enrollees are dually eligible but account for 34% of spending. Similarly, 14% of Medicaid enrollees are dually eligible but constitute 30% of overall spending. In 2019, combined Medicare and Medicaid spending on dual eligibles rose to a total of $440.2 billion.

The COVID-19 pandemic has further exposed the need for reforms to systems of care for dual eligibles. According to federal data, across every demographic group dual eligibles were more likely to contract COVID-19. More concerning, dual eligibles were more than three times as likely to be hospitalized from COVID-19 compared to Medicare only individuals.