Dual Eligibles

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Resources for Integrated Care and Quality

CMS developed a web page of resources for integrated care available for health plans and providers. CMS has been supporting efforts to build provider and health plan capacity to deliver more integrated and coordinated care to Medicare-Medicaid enrollees. These resources are targeted to various types of organizations, including behavioral health providers, health plans, long-term service & support providers. Review the technical assistance and actionable tools developed.

Short URL: http://www.advancingstates.org/node/65538

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State Medicaid Directors Letter: Application of Liens, Adjustments and Recoveries, Transfer-of-Asset Rules and Post-Eligibility Income Rules to MAGI Individuals

This letter provides guidance to states on how the long-term services and supports-related rules, including the estate recovery rules, in section 1917 of the Social Security Act (the Act), and federal regulations at 42 C.F.R. 435.700, et seq., apply to individuals who are eligible for Medicaid under Modified Adjusted Gross Income (MAGI) eligibility rules (“MAGI individuals”) and receive coverage for long-term services and supports (LTSS).

Short URL: http://www.advancingstates.org/node/61324

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Application of Existing External Quality Review Protocols to Managed Long Term Services and Supports

This guidance document is intended to provide guidance to states on how to apply the revised protocols for External Quality Review (EQR) of Medicaid managed care organizations, released in 2012, to managed long term services and supports (MLTSS) programs. Although the protocols already apply to MLTSS generally, this document offers specific suggestions to make their application to long term services and supports (LTSS) clearer and provides suggestions, examples and illustrations.

Short URL: http://www.advancingstates.org/node/60531

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Two-Thirds of States Integrating Medicare and Medicaid Services for Dual Eligibles

New research from AARP and ADvancing States finds that two-thirds of states either have or will launch new initiatives to better coordinate care for people who are dually eligible for Medicare and Medicaid services over the next two years. To contain the growth of costs and improve care, many are moving to risk-based managed long-term services and supports models. This research finds that a number of states are exploring approaches to dual services integration outside of the CMS models.

Short URL: http://www.advancingstates.org/node/53368

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Analysis of the National Commission on Fiscal Responsibility and Reform

Bowles and Simpson, the co-chairs of the National Commission on Fiscal Responsibility and Reform drafted their recommendations to achieve fiscal sustainability. This analysis provides an overview of the commission’s formation, its structure and recommendations, and its potential impact on the aging and disability networks. The report’s legislative recommendations have implications for Medicaid, Medicare, Social Security, Community Living Assistance Services and Supports (CLASS), and more.

Short URL: http://www.advancingstates.org/node/53149

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State Medicaid Integration Tracker©

Published monthly, this report and website tool focuses on state actions in managed care for people who receive Medicaid-funded LTSS and on state initiatives relating to services and costs. The Tracker includes updates on State Demonstrations to Integrate Care for Dual Eligible Individuals, the Balancing Incentives Payment Program (BIPP), states developing or implementing Medicaid State Plan amendments under §1915(i), and states pursuing the Communities First Choice Option under §1915(k).

Short URL: http://www.advancingstates.org/node/53113

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The Continuity of Medicaid Coverage: An Update

This report describes research conducted on the continuity of enrollment of Medicaid beneficiaries. Continuous enrollment in a health insurance plan promotes chronic disease management and is more cost-effective. The research found that Medicaid beneficiaries are on average enrolled in the program for just 9.7 months out of the year. This disruption in enrollment leads to higher monthly medical costs and interferes with efforts to measure quality of care delivered through Medicaid.

Short URL: http://www.advancingstates.org/node/53389

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State and Local Governments' Fiscal Outlook: April 2013 Update

An updated fiscal outlook of state and local governments projects an ever increasing gap between receipts and expenditures through 2060, absent any policy changes. The report found that this decline in the state and local government sectors' operating balance is primarily due to rising health related costs of state and local expenditures on Medicaid and the cost of health care compensation for state and local government employees and retirees.

Short URL: http://www.advancingstates.org/node/53383

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Integrating Medicare and Medicaid: Webinar

In light of the 26 states that have applied to the Centers for Medicare and Medicaid Services for permission to integrate Medicare and Medicaid for dual eligibles, the webinar explained the processes involved in the demonstrations, with a focus on how the new systems will affect both assisted living and long-term services and supports. Visit the website to download a recording and slides from the presentation.

Short URL: http://www.advancingstates.org/node/53331


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