Opinion: I worked for CMS. Even I struggle to help family navigate dual eligibility
Three months ago, my aunt Margaret had a stroke. Days before, she was repainting her bathroom and driving herself. Now, she needs help with dressing and getting in and out of bed, and our family is grappling with the fact that this fiercely self-sufficient woman will never live independently again.
This health crisis has been compounded at every turn by failures of the health care system — failures that are particularly infuriating to me because I have devoted my life to solving these very problems. I previously served as chief strategy officer at the Center for Medicare and Medicaid Innovation, and my aunt is part of a group for whom policymakers (including me) have long sought to improve care: She is eligible for both Medicare and Medicaid. The roughly 12.5 million Americans with “dual eligibility” are among the most high-need patients served by the health care system, qualifying for Medicare due to age or disability and qualifying for Medicaid based on income. They make up 17% of the Medicare population but account for 33% of Medicare spending.
