Texas Announces Plans to Combine Medicare and Medicaid Benefits

For people who receive both Medicare and Medicaid benefits from the state of Texas, things might be getting a whole lot easier. The state of Texas just received approval from the federal government to test an idea that would combine the delivery of Medicare and Medicaid benefits to individuals enrolled in both programs.

Why the Change?

Officials say that the combination of the two services could help make it simpler for enrollees to receive their benefits while also potentially reducing costs for both the state and federal governments.

“Combining a person’s Medicaid and Medicare services into one plan makes sense for the consumer and for the taxpayer,” said Chris Traylor, chief deputy commissioner of the Texas Health and Human Services Commission. “We’ll be able to improve the coordination of care, helping people get the right care in the right setting, and we can save money for both the state and federal governments.”

Right now, Medicare pays for the covered services and then Medicaid picks up the rest of the tab afterwards. By merging the benefit services, it could help coordinate communication between the different programs and encourage better management of care that serves both programs, instead of only financially benefitting one. The new idea could help save money because combining the two services would increase the incentive to support policies that reduce the need for hospitalization, thereby cutting back on inpatient hospital stays and institutional care.

Who is Eligible?

400,000 people living in Texas are currently receiving benefits from both Medicare and Medicaid. Those people are eligible for Medicare based on either their age or disability and simultaneously eligible for Medicaid because of their income status. People enrolled in both programs are referred to as “dual eligibles”.

The program will be piloted in 6 Texas counties that include 168,000 of the dual eligible Texans. In order to enroll in the pilot program, you must be at least 21 years of age. The pilot will begin on March 1, 2015 and information will be sent out to eligible residents in January of next year.

For those who are dual eligible, the long term care expenses that Medicare doesn’t cover are picked up by Medicaid. For those who only qualify for Medicare (and therefore will not be included in this new program), it’s important to remember that despite your age, Medicare does not cover all of your health care expenses. There are many different kinds of out of pocket expenses that Medicare will not pay for, including long term care, which can be extremely expensive. Read more details about the upcoming programĀ here.

To learn more about the cost of long term care in Texas, click here.

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