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
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.
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. Additionally, 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.
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.