Medicaid/Medicare Integration: Opportunities for States & Dual Eligibles

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CHCS Center for Health Care Strategies, Inc. 1 Medicaid/Medicare Integration: Opportunities for States & Dual Eligibles National Medicaid Congress June 5, 2006 Melanie Bella Vice President for Policy Center for Health Care Strategies

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Medicaid/Medicare Integration: Opportunities for States & Dual Eligibles. National Medicaid Congress June 5, 2006. Melanie Bella Vice President for Policy Center for Health Care Strategies. Medicaid/Medicare Integration. - PowerPoint PPT Presentation

Transcript of Medicaid/Medicare Integration: Opportunities for States & Dual Eligibles

Page 1: Medicaid/Medicare Integration: Opportunities for States & Dual Eligibles

CHCSCHCSCenter forHealth Care Strategies, Inc.Center forHealth Care Strategies, Inc.

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Medicaid/Medicare Integration: Opportunities for States & Dual Eligibles

Medicaid/Medicare Integration: Opportunities for States & Dual Eligibles

National Medicaid CongressJune 5, 2006

Melanie BellaVice President for PolicyCenter for Health Care Strategies

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Medicaid/Medicare IntegrationMedicaid/Medicare Integration

• States increasingly interested in integration of acute, long term, and behavioral services for dual eligibles

• Integration of administrative requirements, service delivery, and financing

• Medi-Medi demo states: Massachusetts, Minnesota, Wisconsin

• New models: New York, New Mexico, Washington, Florida

• Potential of Special Needs Plans (SNPs) created in the Medicare Modernization Act (MMA)

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Integrated Care Program (ICP)Integrated Care Program (ICP)

• 2-year Initiative - Launched December 2005

• 5 Grantee States: Florida, Minnesota, New Mexico, New York, Washington

• Objectives:– Provide technical assistance and training for

the development and implementation of integrated care programs;

– Facilitate and/or support the planning for state contracting with Medicare Advantage Special Needs Plans (SNPs); and

– Move the market toward fully integrated care by increasing awareness and buy-in, fostering innovation, evaluating models of integrated care, and disseminating best practices. 3

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State Program NamePopulation Benefits

Seniors PWD Acute LTC BH

Florida Senior Care 60+    

Minnesota

MN Senior Health Options (MSHO)

MN Disability Health Options (MnDHO)

MSHO MnDHO    

New MexicoCoordinated Long

Term Care  

New York

Medicaid Advantage    

Managed LTC/ Integrated Care

Program NHC NHC  

WashingtonMedicare Medicaid Integration Program

to be adde

d

State ICP ProfilesState ICP Profiles

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StateGeography Enrollment

Contract with Special Needs Plans

(SNPs)

Pilot Statewide Mand Vol Currently Planned

Florida 2 areas   1 pilot area

1 pilot area

Minnesota

New Mexico TBD

New York Med Adv

Washington

State ICP Profiles (cont’d)State ICP Profiles (cont’d)

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Why Are States Interested?Why Are States Interested?

• Improve coordination of care via enhanced care management, preventive services

• Achieve virtual integration of administration, financing, and benefits via Medicaid contract with a SNP

• Utilize portion of Medicare rates to fund non-institutional LTC and supportive services

• Incorporate consumer direction

• Increase number and duration of duals being served in their homes and communities

• Establish accountability for delivery, coordination, and management of quality care to high-risk dual eligibles

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ChallengesChallenges

• Encouraging Enrollment: Mandatory vs. voluntary

• Developing LTC Rates: How to use MDS (nursing facility), OASIS (home health), measures of functional status, HCBS services, etc.

• Cost Shifting: Financial misalignment between Medicare and Medicaid

• Building 3-Way Relationships: Effective, timely communication among state, CMS, plans

• Maintaining Focus: Superior care models and delivery for specialized populations

• Understanding Medicare World: Regulatory expertise; access to capital for Medicaid plans

• Future of SNPs

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•Administrative Simplification

– Enrollment/Eligibility

– Marketing

– Monitoring & Reporting

– Grievances & Appeals

•Rate Setting/Risk Adjustment

•Performance Measures

ICP Focus AreasICP Focus Areas

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Early Results Early Results

•Solid partnership with CMS; cross-agency commitment to address administrative barriers to integration

– Examples: Integrated marketing material model documents; joint enrollment form; model marketing material review process

•Rate setting and risk adjustment checklist for states; model contract language

•Recommended performance domains (e.g. care coordination, behavioral health, transitions) and measures within each domain

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Questions??Questions??


Transitions: Moving Dual Eligibles to Medicare Prescription Drug Coverage

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