Dual Eligibles

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Explaining the State Integrated Care and Financial Alignment Demonstrations for Dual Eligible Beneficiaries

This document provides an overview of the joint efforts of states and the CMS to develop more integrated ways of paying for and delivering health care to the 9 million people who are eligible for both the Medicare and Medicaid programs. As an outgrowth of the Affordable Care Act, CMS is reviewing proposals from states to test two new models to align Medicare and Medicaid benefits and financing for dual eligible beneficiaries with the goal of delivering better coordinated care and reducing costs.

Short URL: http://www.advancingstates.org/node/53293

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Care Coordination for Dually Eligible Medicare-Medicaid Beneficiaries

The coordination of Medicare and Medicaid benefits and services for dually eligible enrollees has been a longstanding policy challenge. Several provisions of the Affordable Care Act (ACA) attempt to address this lack of coordination. This paper reviews the major changes under the ACA directed at care coordination for the dually eligible population and then concludes with a discussion of the continuing legislative and legal challenges in integrating care for the dually eligible.

Short URL: http://www.advancingstates.org/node/53137

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Status of States’ Dual Demonstration Grants

Centers for Medicare and Medicaid Services (CMS) has provided funding and technical assistance to states to develop state plans' to coordinate care for dual eligibles, persons eligible for both Medicare and Medicaid. This chart shows the status of those states selected for the Dual Demonstration grants, the model chosen, and target implementation. It also includes links to each state's plan.

Short URL: http://www.advancingstates.org/node/53127

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Medicare-Medicaid Enrollee State Profiles

Today there are over 9 million Medicare-Medicaid enrollees in the United States. To provide a greater understanding of the Medicare-Medicaid enrollee population, Centers for Medicare & Medicaid Services has put together individual State profiles that examine the demographic characteristics, utilization, and spending patterns of Medicare-Medicaid enrollees and the programs that serve them in each State. Also review the National Summary Profile.

Short URL: http://www.advancingstates.org/node/53123

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Integrated Care Models For Dual-Eligible Beneficiaries

As state and federal policymakers move to develop and test integrated care models for people dually eligible for Medicare and Medicaid, two new Kaiser Family Foundation articles in the June 2012 issue of Health Affairs highlight the diverse needs and challenges facing these 9 million beneficiaries, describe their current care arrangements, and raise issues to consider for proposed reforms aimed at better coordinating their care and reducing health care spending.

Short URL: http://www.advancingstates.org/node/53118

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Emerging Medicaid Accountable Care Organizations

An Accountable Care Organization (ACO) is a provider-run organization in which the participating providers are collectively responsible for the care of an enrolled population. This brief examines the existing Medicaid payment and care delivery landscape in states undertaking Medicaid ACO initiatives to gain insights into how ACOs fit into states’ Medicaid programs, and to identify important differences between Medicaid ACOs and ACOs in Medicare and the private insurance market.

Short URL: http://www.advancingstates.org/node/53114

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An Overview of Recent Section 1115 Medicaid Demonstration Waiver Activity

Section 1115 waivers provide states an avenue to test new approaches in Medicaid that differ from federal program rules. Waivers can provide states significant flexibility in how they operate programs and can have a significant impact on program financing. As such, waivers have important implications for beneficiaries, providers, and states. This brief provides an overview of Section 1115 waiver authority, the waiver approval process, and recent waiver activity and discusses the implications.

Short URL: http://www.advancingstates.org/node/53112

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Flexible Accounting for Long-Term Care Services: State Budgeting Practices that Increase Access to Home-and Community-Based Services

This report presents budgeting and contractual strategies used in Arizona, Hawaii, Louisiana, Massachusetts, Michigan, Minnesota, New Jersey, Pennsylvania, Tennessee, Texas, Washington and Wisconsin. In different ways, these states have made substantial progress in transforming their LTSS systems by developing flexible accounting policies that have reduced NF utilization and captured the savings to support their HCBS programs.

Short URL: http://www.advancingstates.org/node/53086

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Financial Alignment Models for Medicare-Medicaid Enrollees: Considerations for Reimbursement

The 9 million individuals enrolled in both Medicare and Medicaid often receive care that is fragmented, poorly coordinated, and high-cost. Integrating their care is difficult because of the challenges associated with aligning the programs' financial incentives and reimbursement processes. This brief explores considerations for establishing reimbursement rates and performance incentives for the capitated and managed fee-for-service financial models.

Short URL: http://www.advancingstates.org/node/53049

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