U.S. Senator Bill Cassidy, MD, (R-LA), left, and Mount Sinai medical student Sunjay Letchuman
With the annual Medicare open enrollment period approaching, Mount Sinai medical student Sunjay Letchuman (class of 2026) and U.S. Senator Bill Cassidy, MD, (R-LA) have come together to shine a light on a vulnerable population of Americans who are poor, elderly, and sometimes disabled. This group of more than 12 million Americans is so called “dually eligible” because they qualify for insurance through both Medicare and Medicaid.
Having two forms of insurance might seem to be better than one. But data reveal that dually eligible individuals experience worse health outcomes when compared to similar populations, even after controlling for confounding variables. These poor health outcomes result, in part, from the lack of payment coordination between Medicare and Medicaid.
“Medicare pays for most hospital services while Medicaid pays for long-term care services, such as nursing home care,” says Mr. Letchuman. “Without payment coordination between the two insurers, Medicaid does not know that a dually eligible patient is hospitalized unless subsequent long-term care is needed. As such, Medicaid has no financial incentive to prevent the hospitalization in the first place in light of Medicare’s responsibility to pay. This is just one illustration of how poor coordination is not serving these patients, who experience longer hospitalizations and higher costs.”
This summer, Mr. Letchuman, raised in Louisiana, had the unique opportunity to research this policy issue while serving as a Health Fellow for Dr. Cassidy. While working together, Dr. Cassidy suggested they co-author an article to draw attention to the problem. The result: a Viewpoint essay published in JAMA September 15 titled, “A Prescription for Americans Dually Eligible for Medicare and Medicaid.”
“It was a pleasure to co-author this piece with my health fellow, medical colleague, and Shreveport, Louisiana, native Sunjay Letchuman,” says Dr. Cassidy. “Dually eligible patients have poor outcomes, despite society devoting significant resources to pay for their care. Sunjay spent his time as a health fellow learning this issue and, as importantly, using this understanding to help develop solutions. He is a health scholar serving patients, profession, and country by other means. This editorial is a manifestation and furtherance of this service.”
Mount Sinai medical student Sunjay Letchuman with a patient
In their JAMA article, the pair conclude that the federal government should establish guidelines requiring care to be coordinated between Medicare and Medicaid at the state level. Dr. Cassidy is part of a bipartisan group of six senators working to get this done. The issue is of particular relevance to New York as the state is home to a high number of dually eligible Americans, as is the case in the two authors’ home state.
“Addressing the needs of dually eligible Americans is more than just a policy interest of mine; it’s a commitment to serve my home state of Louisiana where more than 250,000 dually eligible Americans live and deserve better coordinated care and improved health outcomes,” says Dr. Letchuman.
This was not Mr. Letchuman’s first deep dive into a health policy issue. Over the summer, he also co-authored an article in the New England Journal of Medicine about whether nonprofit hospitals deserve their tax exemptions—an issue he worked on as a health fellow for the U.S. House Committee on Ways and Means.
“In exchange for not paying taxes, nonprofit hospitals are required to provide substantial community benefit and charity care. Not all nonprofit hospitals fulfill this commitment, and local communities pay the price,” he says.
Mr. Letchuman studied the business of health care as an undergraduate, which has helped prepare him for a career in both medicine and health policy. This made him a perfect candidate for the Icahn School of Medicine at Mount Sinai’s FlexMed program, which encourages college sophomores in any major to apply and provides students with the flexibility to pursue their academic passions during college. Mount Sinai was the first medical school to create an admissions pathway that provides such early assurance.
“The FlexMed program allowed me to pursue my health policy dreams early in college,” he says. “I am confident that Mount Sinai’s education and support, then and now, are shaping me into a more effective physician and policymaker.”