Dual Eligibles

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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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The Center for Medicare and Medicaid Innovation: Activity on Many Fronts

In its first year of operation, the Center for Medicare and Medicaid Innovation has a long list of accomplishments, yet some observers express concern that its fast-paced approach may be overwhelming to smaller delivery systems. A status report of the Innovation Center’s activities to date is provided, including delineating the goals envisioned by Congress, detailing the new tools it was given, and emphasizing how the enhanced authority compares with CMS’ traditional demonstration programs.

Short URL: http://www.advancingstates.org/node/53043

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On the Verge: The Transformation of Long Term Services and Supports

Many states are undergoing long-term services & supports (LTSS) transformations. The lagging economy & increased demand for publicly funded LTSS are placing pressure on state policymakers to find solutions. As a result, many states either have or plan to implement Medicaid Managed LTSS, with 12 states having existing programs & another 11 with plans for implementation. Many states used the economic downturn as an opportunity to balance services from institutional to non-institutional settings.

Short URL: http://www.advancingstates.org/node/53034

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CMS Informational Bulletin: Implementation of Section 3309 of the Affordable Care Act

This bulletin provides information that CMS hopes will be helpful to States as they work to implement section 3309 of the Affordable Care Act which eliminates Part D cost-sharing for full benefit dual eligible individuals receiving home and community-based services. The effective date for Section 3309 is January 1, 2012.

Short URL: http://www.advancingstates.org/node/53031

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Communicating the Value of Integrated Care to Stakeholders

This policy brief is part of Center for Health Care Strategies’ Technical Assistance for Dual Eligible Integrated Care Demonstrations program, made possible through The SCAN Foundation and The Commonwealth Fund. Through this program, CHCS is helping demonstration states develop and implement integrated-care models for individuals eligible for both Medicare and Medicaid services.

Short URL: http://www.advancingstates.org/node/53014

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Medicaid and Medicare Resource Use for Dual Eligibles in Maryland

This presentation, delivered by Charles Milligan to the Medicaid and CHIP Payment and Access Commission (MACPAC) in Washington, D.C., addressed the issue of coordinating long-term care for persons eligible for both Medicare and Medicaid (dual eligibles). Milligan discussed Hilltop's research on Medicare/Medicaid cross-payer effects that found that Medicare and Medicaid financing do not align to promote home and community-based services.

Short URL: http://www.advancingstates.org/node/52984

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Rebalancing Long-Term Services and Supports: Progress to Date and a Research Agenda for the Future

This report, which was presented at the Long-Term Care Interest Group Colloquium at the June 2011 AcademyHealth Annual Research Meeting in Seattle, Washington, discusses progress in rebalancing Medicaid long-term services and supports (LTSS) spending, how the Affordable Care Act can support states’ continued efforts to rebalance LTSS, and opportunities for future research to support continued system transformation.

Short URL: http://www.advancingstates.org/node/52982

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A Profile of Medicaid Managed Care Programs in 2010: Findings from a 50-State Survey

Most Medicaid beneficiaries are enrolled in some form of managed care. States are expected to increase their reliance on managed care to deliver services in their Medicaid programs. This 50-state survey provides a comprehensive look at state Medicaid managed care programs, documenting their diversity, examining how states monitor access and quality, and exploring emerging efforts to improve care, including managed long-term care and initiatives targeted toward dual eligibles.

Short URL: http://www.advancingstates.org/node/52976

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Managing the Care of Dual Eligible Beneficiaries: A Review of Selected State Programs and Special Needs Plans

To improve beneficiary care and reduce unnecessary expenditures, a number of states have developed programs and initiatives aimed at improving the coordination and management of care for dual eligibles—beneficiaries enrolled in both Medicaid and Medicare for their health care services. This report reviews the experiences in nine states to determine the lessons that can be learned from experience.

Short URL: http://www.advancingstates.org/node/52949

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Ensuring Consumer Protection for Dual Eligibles in Integrated Models

This issue brief is the first in a series of four papers designed to highlight pressing issues facing dual eligibles and provide recommendations to the Medicare-Medicaid Coordination Office, state Medicaid agencies and other interested policymakers and stakeholders on how to address them. This first paper provides recommendations for consumer protections in delivery system models that integrate Medicare and Medicaid.

Short URL: http://www.advancingstates.org/node/52943

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