In the past two months, the coronavirus pandemic has quickly permeated American life and placed many populations at serious health risk. COVID-19 disease has devastated communities of color, with the Black community disproportionately impacted. It has placed individuals who are living with disabilities at severe health risk, as well as the additional risk of being denied life-saving care due to many states’ ventilator triage policies deprioritizing them as a class. Furthermore, our older adult population is particularly vulnerable to contracting COVID-19 – those living in the community, as well as those in nursing homes or assisted living facilities.
And then there is a population that comprises all of the above and more: people dually eligible for Medicare and Medicaid (dual eligibles). This population is poorer, sicker and disproportionately, from communities of color. They have higher rates of chronic conditions, greater reliance on long-term services and supports, at least one mental health condition and increased social risk factors. In short, dual eligibles have a greater level of complex health and social needs, all of which make them more vulnerable to contracting COVID-19 and to suffering worse outcomes when they do.
Pre-pandemic, there was a growing consensus that care coordination is the lynchpin for improving outcomes for dual eligibles. And there was agreement that successful coordination has to be person-centered: engaging people to identify their goals and preferences (e.g., asking, “what matters to you and what do you want from your care?”), and supporting and empowering dually eligible individuals to achieve those goals using culturally and linguistically appropriate methods. Person-centered care remains every bit as relevant during this pandemic, and as the care coordination function for this population (as with many others) shifts to telehealth, understanding the person’s goals and needs are paramount.
The Centers for Medicare and Medicaid Services (CMS) have begun taking steps to ensure dual eligibles’ safety. For example, CMS recently released updated guidance for health plans that serve this population. It includes items like replacing in-person interactions with telehealth to reduce the risk of coronavirus transmission, urging Medicare Advantage (MA) plans, including the many MA plans that care for dual eligibles, to implement a policy of “deemed continued eligibility” for six months in case a person loses their Medicaid eligibility, and allowing a 90-day supply of prescription drugs.
Still, there are areas for further improvement. At Community Catalyst, we developed a set of federal policy priorities that aims to protect our most vulnerable populations. Among our priorities, are several recommendations from the Center that will safeguard dual eligible enrollees, as well as non-dual older adults and people with disabilities during the coronavirus era.
For dual eligibles specifically, we call for a continuous special enrollment period (SEP). Dually eligible beneficiaries are currently only able to change their Medicare Advantage or Part D plan enrollment once per quarter. As noted earlier, these are individuals who are living in poverty and very often are dealing with complex medical and social needs. They do not have the financial means to survive disruptions or denial of care when they find the plan they are in does not meet their immediate needs. This is particularly problematic during this current crisis, as their care and treatment needs are very likely to change. Providing a continuous SEP would reduce administrative complexity and mitigate disruptions in coverage and barriers to accessing needed care. Additional Center recommendations for the next round of Congressional action include:
- Increase the federal share of Medicaid funding, known as FMAP (federal medical assistance percentage) in a way that helps all states absorb new demand, including those that have not yet expanded Medicaid.
- Pass the Coronavirus Relief for Seniors and People with Disabilities Act (S. 3544), including its Home and Community Based Services grants to support the Direct Support Professional and Home Health Workforce. This bill is vital to supporting older adults and people with disabilities in their homes and communities, keeping them out of congregate spaces that are high risk.
- Ensure protection and adequate funding to support home health workers and essential workers.
- Boost the maximum SNAP benefit levels by at least 15 percent to ensure older adults and their families have access to food during this emergency. In addition, we recommend increasing the minimum SNAP benefit from $16 to $30; and suspend all SNAP administrative rules that would terminate or weaken benefits.
- Collect transparent disaggregated data that will allow for community recovery and help us in identifying and responding to historic and longstanding health inequities.
Again, these recommendations are just a few of an extensive list of priorities that we have laid out. As federal policymakers debate the next set of relief policies, advocates must continue to fight to bring the needs of our most vulnerable older adults and people with disabilities to the forefront.