States aim to improve health needs of dual-eligibles

Integrating, aligning Medicare and Medicaid 'top priority' for states

Twelve states are teaming with the Centers for Medicare & Medicaid Services (CMS) to establish three-year dual-eligible demonstration programs with the hopes of improving the health needs of the Medicare-Medicaid dual-eligible population, reports Healthcare Payer News.

With the goal of aligning Medicare and Medicaid services, states are taking matters into their own hands by integrating major aspects of the programs--finances, delivery of benefits and overall experience. California, Illinois, Massachusetts, Michigan, New York, Ohio, South Carolina, Texas and Virginia are testing a new capitated financial alignment model. Colorado is toying with a fee-for-service payment model, while Washington is testing both a capitated and FFS model. Minnesota is focusing on an integration of administration.

In a recent letter to CMS officials, Medicaid directors stressed that "integration and alignment between the two programs continues to be a top priority for states," wrote Darin Gordon and Thomas Betlach, Medicaid directors for Tennessee and Arizona, respectively, who also serve as president and vice president of the National Association of Medicaid Directors (NAMD). Gordon and Betlach also note the need to "exchange existing integration pathways and develop new approaches."

The letter said that, to prevent beneficiary disruptions, states must begin continuity of care planning; additionally, they should start doing their own budgeting.

In order for states to have certain flexibilities when it comes to aligning both Medicare and Medicaid for the given population, CMS must provide some level of administration. "States and health plans will need additional resources and clear guidance on these tools, including through enhancement of their Medicare Improvements for Patients and Providers Act contracts," Gordon and Betlach wrote.

Increased state efforts to combine their Medicare and Medicaid programs in order to save money on care provided for enrollees matters. The dual-eligible population accounts for almost 40 percent of the overall Medicaid costs, which is about $110 billion a year, FierceHealthFinance previously reported. In Medicare, dual-eligibles account for 30 percent of the costs, or more than $162 billion a year.

For more:
- here's the Healthcare Payer News article
- check out the letter (.pdf)

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