Feds Approve RI Plan to Coordinate Care For Dual Eligibles

Jul 31, 2015

Rhode Island has been given the green light for a pilot program to coordinate health care for people enrolled in both Medicare and Medicaid. They're known as “dual eligibles” and have to navigate two complex systems to get the care they need.

Medicaid is the state health insurance program for low income Rhode Islanders. Medicare is federal health insurance for seniors. Disabled Rhode Islanders and low-income seniors can qualify for both. But each program covers different services. Confused? Now you know what it’s like to be a dual eligible. You carry two insurance cards. Navigate two different networks of doctors and services.

Plus many of Rhode Island’s 30,000 dual eligibles are chronically ill, so they need lots of services.

The new program lets Rhode Island pool money from Medicaid and Medicare in one pot to cover doctors and hospitals as well as nursing home stays and home care. Patients who opt in get one insurance card and a team to coordinate their health care. The goal is to reduce cost by preventing extra doctor’s visits and keeping patients in the community longer.