According to Lynda Flower, a Senior Strategic Policy Advisor for the health team at AARP’s Public Policy Institute, two-thirds of the states are integrating Medicare and Medicaid services for dual eligibles. Today, roughly 10.2 million peoples are dually eligible for both Medicaid and Medicare services and 7.4 million are eligible for both Medicare and full Medicaid benefits typically referred to as full benefit duals. Although dual eligibles are diverse as a group, these individuals are typically poorer and sicker than other Medicare beneficiaries, use more healthcare services, and account for a disproportionate share of both Medicare and Medicaid spending.
The issues and problems in serving dual eligibles was presented at the Alliance for Health Reform briefing on “Medicare-Medicaid Coordination for Dual Eligibles: What’s it all about?” held on May 13, on Capitol Hill.
Michelle Herman Soper, Senior Program Officer for the Center for Health Care Strategies pointed out that integrated care has many problems. Today, care is fragmented, not coordinated, complicated and difficult to navigate, gaps in care exist, not focused on the individual, cost shifting exists between states and the federal government, and incentives are lacking to promote community-based care.
Soper, explained that the CMS Medicare-Medicaid Coordination Office (MMCO) provides financial incentives for states to coordinate the care for duals and has established state demonstrations to integrate care. So far, CMS has selected 15 states to design new approaches to coordinate care and each state has received up to $1 million to design and implement a duals integration program.
Twenty six states submitted proposals to participate in MMCO’s financial alignment initiative between the Medicare and Medicaid programs. The financial alignment initiative is in place to test a Capitated Model where the state and CMS and a health plan enter into a contract and receive set risk-based payments from Medicaid and Medicare. A second initiate referred to as the Managed Fee-for-Service Model enable an entity to receive a payment to coordinate the care of duals.
Greg Moody, Director of Ohio Governor’s Office of Health Transformation told the attendees that Ohio is just one of the states working towards an Integrated Care Delivery System (ICDS) to help dual eligibles.
The state plans to initiate a Payment Innovation Task Force in 2013 to participate in payment reform, provide access to medical homes, use episode-based payments for acute medical events, pioneer ACOs, accelerate electronic health information exchanges, promote insurance market competition, and support regional payment innovation.
Ohio’s Capitation Model with an anticipated start date of September 2013 is dealing with a population of 115,000 full benefit duals age 18 and older and serves 29 counties grouped into seven regions. The current status of Ohio’s ICDS is that an integrated enrollment process has been developed, two complicated data systems have meshed, actuarially sound capitation rates have been developed, and marketing guidelines are being developed.
For more information, go to www.allhealth.org.