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CMS’ Untested Model Potentially Threatens Frailest Nursing Home Residents  
CMS’ Untested Model Potentially Threatens Frailest Nursing Home Residents
States and health plans lack experience with this sector, Parkinson says
Michael Cowden
(202) 898-3165


Washington, DC – The following is a statement from American Health Care Association (AHCA) President & CEO Mark Parkinson in response to the Senate Aging Committee’s hearing today examining Medicare-Medicaid coordination of the dual eligible population:

“The dual eligible population is the poorest and frailest that nursing homes treat, and any effort to save money in this population must be done very, very carefully.  Coordination of benefits and other efforts should focus on better health for these seniors with an outcome of savings to the taxpayer.  CMS’ capitated, risk-based approach for dual eligibles is extremely concerning because the main focus appears to be reducing financial resources to this population and not providing better care.

“Instead of guiding states toward the development of a controlled, defined array of pilot demonstrations intended to benefit both the taxpayer and our residents, CMS appears to have led states toward de facto enrollment of all individuals who are fully eligible for Medicare and Medicaid into an entirely new system.  This structure is unproven and risks disrupting care delivery to over 9 million Americans.

“The states and managed care plans lack the experience necessary to deal with the frailest residents in long term care.  We encourage Congress to reject this plan, and look forward to working with CMS and lawmakers to find a more phased alternative which will allow states to develop needed expertise.”

Early last month, AHCA issued a letter with full recommendations on how CMS should proceed with its pilot program concerning Medicare-Medicaid eligibles. The letter stressed beneficiary education and expressed concern regarding “passive enrollment” and that further development should be as transparent as possible. AHCA also expressed concerns surrounding separate state implementation, worrying that a “patchwork” of programs could evolve in their wake.

The American Health Care Association and National Center for Assisted Living (AHCA/NCAL) represent more than 13,000 non-profit and proprietary skilled nursing centers, assisted living communities, sub-acute centers and homes for individuals with intellectual and developmental disabilities. By delivering solutions for quality care, AHCA/NCAL aims to improve the lives of the millions of frail, elderly and individuals with disabilities who receive long term or post-acute care in our member facilities each day. For more information, please visit or