34 States Integrating Medicare & Medicaid Services For Dual Eligibles

NYAPRS Note: The following summarizes how 2/3 of the states are in various processes of launching new initiatives to integrate the care for people with both Medicaid and Medicare coverage.Next week's NYAPRS Seminar will feature a NYS update on our "Fully- Integrated Duals Advantage program" (FIDA) by the Department of Health's Mark Kissinger as well as where we are in implementing newly approved Managed Long Term Waiver and Community First Choice programs. Mark will be joining by advocates Leah Farrell of the Center for Disability Rights and the NYS Association on Independent Living's Lindsay Miller. Online registration for the Seminar has been extended into next week. For more details, please go to https://registration.nyaprs.org/.

34 States Integrating Medicare & Medicaid Services For Dual Eligibles Open Minds April 15, 2013

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Two-thirds of states (34) have started or are planning to launch new initiatives to better coordinate care for people who are dually eligible for Medicare and Medicaid services. Four of the 34 states-Delaware, Idaho, Minnesota, and Massachusetts-have already implemented initiatives. Of the remaining 30 states, 10 are planning to implement a program during 2013, and 11 are planning to implement one in 2014. The remaining nine states are in early planning stages or uncertain about the timing of the program launch.

As of February 2013, of the 26 states that had submitted plans to participate in a Medicare-Medicaid Coordination Office (CMMO) financial alignment initiative, five had withdrawn-Hawaii, Minnesota, New Mexico, Oregon, and Tennessee. About 75% of the states planning to launch an initiative for dual eligibles are planning to use a risk-based managed care model. Seven states are planning to implement a managed fee-for-service model or primary care case management structure, and one is planning an accountable care organization structure.

The status of the state's dual eligible initiatives was reported in "Two-Thirds Of States Integrating Medicare & Medicaid Services For Dual Eligibles" by Jenna Walls of Health Management Associates; Wendy Fox-Grage and Kathleen Ujvari of the AARP Public Policy Institute; and Diana Scully, Eunhee (Grace) Cho, and John Michael Hall of the National Association of States United for Aging and Disabilities. The analysis is based on state responses to the 2012 Survey of Long-Term Services and Supports and Economic Trends, the third annual survey the three sponsoring organizations have partnered on. Officials at state Medicaid agencies and state aging and disability agencies completed an electronic survey in the fall of 2012. Responses were received from 48 state Medicaid agencies and 48 state aging and disabilities agencies. The survey asked about the states' plans over the next two years to coordinate care for older adults and adults with physical disabilities eligible for both Medicare and Medicaid. The survey did not ask about care coordination initiatives for dual eligibles with intellectual or developmental disabilities. The survey asked states about anticipated initiative launch timing, the payment model design, and the scope of the initiatives.

A total of 37 states plus the District of Columbia submitted letters of intent and 26 states submitted proposals to federal Centers for Medicare and Medicaid Services (CMS) to participate in the Medicare-Medicaid Coordination Office (MMCO) financial alignment initiative. The financial alignment initiative will test two models: a capitated model in which the state, CMS, and a health plan enter into a three-way contract and the health plan receives a blended capitated rate; or a managed fee for service model where an entity will receive a payment to coordinate care and can gain performance-based payments by meeting or exceeding outcomes benchmarks.

Additional findings are as follows:

* Of the 26 states that submitted proposals, 21 are still negotiating with MMCO. Of the five states that withdrew their proposals Oregon, Minnesota, and Tennessee indicated that they intended to continue discussions with MMCO about a modified proposal. New Mexico is implementing statewide Medicaid managed care that will enroll dual eligibles. Hawaii indicated it would continue to work with CMS to explore the possibility of implementing a financial alignment program. * Four states have signed memorandums of understanding (MOU) with CMS. These states are Illinois, Massachusetts, Ohio, and Washington State. The MOU establishes specific parameters for their financial alignment demonstrations. * Four states are using a managed care delivery system, including managed long-term care services and supports. These states are Delaware, Florida, New Jersey, and New Hampshire. Eight states provided information about the financial alignment models they are pursuing. Among the other four states that responded, Indiana is developing its program design; and Louisiana, Pennsylvania, and Kansas are still in the early planning stages and had not yet defined the program parameters. * Most integration programs are statewide, targeting all full benefit dual eligible; 26 states provided information and 18 were planning a statewide program. Nine states plan to implement initiatives in limited geographic areas. California and Oklahoma described their initiatives as pilots. Seven states were unsure of the geographic scope; these states are Arizona, Indiana, Kansas, Louisiana, New Hampshire, New Mexico, and Pennsylvania. * Twenty states provided details about eligibility criteria and included populations: 19 will include duals age 65 and older; 16 will include duals under age 65; 15 will include adult duals living in institutions; 19 will include duals receiving Medicaid home- and community-based services; and 15 will include adult duals with behavioral health disorders.

The full text of "Two-Thirds Of States Integrating Medicare & Medicaid Services For Dual Eligibles" was published in April 2013; a free copy is available online at http://nasuad.org/documentation/newsroom/press_releases/Two-Thirds%20of%20States%20Integrating%20Medicare%20and%20Medicaid%20Services%20for%20Dual.pdf (accessed April 11, 2013). For more information, contact: Wendy Fox-Grage and Kathleen Ujvari, AARP Public Policy Institute, 601 E Street, NW, Washington, District of Columbia 20049; 202-434-3890; E-mail: ppi at aarp.org<mailto:ppi at aarp.org>; Website: www.aarp.org/ppi<http://www.aarp.org/ppi>.

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