The Department of Health and Human Services’ (HHS’) latest efforts to provide care for the poorest of the poor are highly flawed, Sen. Jay Rockefeller (D-W.Va.) told Secretary Kathleen Sebelius in a public letter.

The Coordinated Care Office has promulgated what HHS is calling a Financial Alignment Initiative to care for those patients who are eligible for both Medicare and Medicaid. But the care model is hopelessly flawed because it focuses on cutting costs, not on delivering quality care, because it doesn’t test new ideas “rigorously” and doesn’t “guarantee” that dual eligibles can get the same care as Medicare-only patients, Rockefeller said in the letter, dated Monday.

“While I strongly support the Coordinated Care Office’s mission, I am very concerned that the capitated model under the Financial Alignment Initiative, as currently structured, runs counter to both the letter and the spirit of the [Affordable Care Act] …” Rockefeller said.

He urged Sebelius to “take immediate steps to halt this initiative” and “to take the time necessary to develop a well-designed and thoroughly evaluated care coordination model for dual eligibles that meets the standards outlined in the law.”

On the question of cost over care, Rockefeller said that the “most important goal … is to improve the quality of care for each of the different subpopulations of dual eligibles—whether or not such approaches save money.”

The senator said that the current focus “will create an enormous amount of pressure on managed care companies … to take shortcuts in order to achieve savings”—a “particular concern given that some states are proposing to enroll dual eligibles in plans that have not demonstrated their ability to deliver high-quality care for this population.”

Rockefeller is also worried that some states will simply enroll their dual eligibles into the Financial Alignment Initiative without “rigorously” testing new ideas. “Demonstration programs should not start out with a design and scale that arbitrarily assumes the success and universal applicability of the concepts they are intended to test,” Rockefeller wrote. The Centers for Medicare & Medicaid Services “should also test a model that brings care for dual eligibles under the federal umbrella,” he added.

Finally, HHS must “guarantee that dual eligibles retain all the rights and the same access to care” as all other Medicare patients, Rockefeller said. It “is becoming increasingly clear” as details of state models leak out, “that the rights and choices of Medicare beneficiaries … could be diluted,” he wrote.

Rockefeller wants a reply from Sebelius by July 20, the letter said.