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同时符合医疗保险和医疗补助资格:一举两得还是双重风险?

Dually eligible for Medicare and Medicaid: two for one or double jeopardy?

作者信息

Ryan Jennifer, Super Nora

出版信息

NHPF Issue Brief. 2003 Sep 30(794):1-24.

Abstract

This issue brief describes the characteristics of the population of individuals known as "dual eligibles," who are eligible for health insurance coverage through both Medicare and Medicaid. It also looks at the differences between "full Medicaid" and "supplemental Medicaid" dual eligibles and the ongoing challenges associated with enrollment and eligibility, integration and coordination, and managed care. The paper presents several examples of integrated care programs designed to better serve the dual-eligible population, including the Program of All-Inclusive Care for the Elderly, Evercare, social health maintenance organizations, and state/federal initiatives such as the Wisconsin Partnership Program, Texas STAR+PLUS, and others. Finally, it considers the implications for dual eligibles of the House and Senate Medicare prescription drug proposals.

摘要

本问题简报描述了被称为“双重资格者”群体的特征,这些人有资格通过医疗保险和医疗补助获得医疗保险覆盖。它还探讨了“全额医疗补助”和“补充医疗补助”双重资格者之间的差异,以及与登记和资格认定、整合与协调以及管理式医疗相关的持续挑战。本文介绍了几个旨在更好地服务双重资格人群的综合护理项目实例,包括老年人全包护理项目、关爱护理项目、社会健康维护组织,以及威斯康星伙伴计划、得克萨斯州STAR+PLUS等州/联邦倡议。最后,它考虑了众议院和参议院医疗保险处方药提案对双重资格者的影响。

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