About 9 million people in the United States are covered by both Medicare and Medicaid, including low-income seniors and younger people with disabilities. These Medicare-Medicaid eligible beneficiaries have complex and often costly health care needs, and have been the focus of many recent initiatives and proposals to improve the coordination of their care aimed at both raising the quality of their care while reducing its costs.
The materials, below, provide the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) perspective on recent efforts. Other resources provide information on state proposals, and examine the dual eligible population, their health care needs and spending, and ongoing efforts to coordinate care across the two programs.
Current Medicare-Medicaid Integration Efforts
For more information on the financial alignment approaches, click here
. Below is a snapshot comparing the two methods: capitated, risk-based (or managed care) and managed fee-for-service, which states may use under CMS’ current Medicare-Medicaid Financial Alignment Initiative.
Overview of Financial Alignment Methods
MMCO is posting state proposals and accepting comments at the federal level on state proposals on a rolling basis. To learn more, visit the MMCO Integrated Care Resource Center. An overview of state proposals is available here, and below is a snapshot of state levels of interest.
Financial Alignment Initiative State Overview
To-date, CMS and two states have entered into Memoranda of Understanding (MOU), the second step in the financial alignment initiative implementation process. The Commonwealth of Massachusetts received approval first. To view AHCA’s analysis, click here
. Massachusetts is the first example of a managed care approach to Medicare-Medicaid Integration. In October 2012, CMS entered into a second MOU. Under this agreement with Washington State, CMS and the state will implement a statewide managed fee-for-service (MFFS) approach to Medicare-Medicaid integration. For an overview of MFFS as well as an analysis of the Washington State MOU, click here
. An overview of state activity is presented in the map, below.
State-by-State Medicare-Medicaid Financial Alignment Initiative Overview
AHCA Position on Medicare-Medicaid Financial Alignment
AHCA/NCAL supports the overarching goal of offering persons who are Medicare-Medicaid eligible high quality, seamless and cost effective care through integrated, person-centered services. However, the post-acute and long-term care (PAC-LTC) industry has a number of concerns regarding the state Medicare-Medicaid integration proposals.
AHCA/NCAL key concerns include:
Medicare-Medicaid initiatives must be pilot or demonstration projects and serve to inform national Medicare and Medicaid integration efforts. The ACA did not authorize the U.S. Department of Health and Human Services (DHHS) to restructure the Medicare and Medicaid programs for this population but rather test discreet models.
State and managed care plan experience is not well positioned to support rapid program proliferation and expansion particularly in long term care;
People should have ample opportunity to make educated choices about how they will receive their services and supports; and
Provider reimbursement must ensure access and overall provider network operational and financial stability.
To hear from state affiliate executives about existing Medicare-Medicaid integration efforts and reactions from state affiliates with proposed, efforts, view the AHCA duals integration webinar.
For more detail on AHCA/NCAL concerns and related suggestions to enhance the Financial Alignment initiative, click here
to view a June 6, 2012, comment letter transmitted to the Centers for Medicare and Medicaid Services (CMS). Additionally, the National Senior Citizens Law Center has developed a robust website, called Duals Demo Advocacy
on the financial alignment initiative offering talking points from other organizations, copies of other letters sent to CMS, and additional state-by-state information. Finally, the Kaiser Family Foundation released a review of research on previous Medicare-Medicaid integration efforts and found little evidence of cost savings at the levels currently predicted by states and the federal government. To view the report, click here.
State-by-State Duals Data
The Kaiser Family Foundation maintains robust state-by-state data on elements such as the number of Medicare-Medicaid eligibles by state, spending, and managed care enrollment. To learn more about your state’s Medicare-Medicaid eligible population click here
General Accountability Office (GAO) Report on Beneficiary Protections
To help inform efforts to better integrate the financing and care for dual-eligible beneficiaries, GAO (1) compared selected consumer protection requirements within Medicare FFS and Medicare Advantage, and Medicaid FFS and managed care, and (2) described related compliance and enforcement actions taken by CMS and selected states against managed care plans.
GAO identified consumer protections of particular importance to dual-eligible beneficiaries on the basis of expert interviews and literature, including protections related to enrollment, provider networks, and appeals. GAO reviewed relevant federal and state statutes, regulations, and policy statements, and interviewed officials from CMS and four states selected on the basis of their share of dual-eligible beneficiaries and use of managed care (Arizona, California, Minnesota, and North Carolina). GAO analyzed data on compliance and enforcement actions in Medicare Advantage and Medicaid managed care from January 1, 2010, through June 30, 2012. To access the report, click here.