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A look at states' efforts to coordinate care for Medicare, Medicaid populations


Currently 13 states are working to align Medicare and Medicaid financing as well as integrate primary and acute care, behavioral health services and long-term services and supports (LTSS) through a variety of innovative methods, according to a new report from the Center for Healthcare Strategies.

The report says that more 10 million people in the U.S. are dual-eligible beneficiaries, and they are often among the highest-need, highest-cost population. As of March, 10 states--California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, Texas and Virginia--have launched capitated demonstrations. Two states--Colorado and Washington--have launched managed fee-for-service demonstrations; and Minnesota signed an agreement with the Centers for Medicare & Medicaid Services (CMS) for an alternative model focused on administrative alignments.

Other states have taken steps to integrate care for dual beneficiaries in different ways, the report says. One way is through Dual Eligible Special Needs Plans (D-SNPs), which must provide a coordinated Medicare and Medicaid benefit package that offers more integrated care than the typical Medicare Advantage plan. According to the report, when contracted with both state Medicaid agencies and CMS, D-SNPs must:

  • Offer Medicare and Medicaid benefits within a single health plan
  • Create aligned enrollment, benefit and coverage notifications for beneficiaries and providers
  • Provide enrollees with a care/service coordinator and a comprehensive provider network to access care

Other strategies include fully integrated plans, all-inclusive care for the elderly, and managed long-term care and services and support.

"States are taking advantage of unprecedented federal support as they advance alignment of Medicare and Medicaid services for dually eligible beneficiaries," the report says. "States and their federal partners will continue to refine the opportunities described here and possibly develop other alternative pathways."

Such innovations are already paying off. Early results from a demonstration in Washington State, which ran from July 2013 to December 2014, showed a reduction of $21.6 million in Medicare spending

To learn more:
- read the full report (.pdf)

Related Articles:
Dual-eligible pilot program shows promising early results
Michigan joins Medicare-Medicaid integration trend
Medicare Advantage ratings hurt insurers with dual-eligible members