Report Profiles 15 States’ Plans for Dual Eligibles

States continue to move forward with efforts to better coordinate care for people who have both Medicare and Medicaid, also known as dual eligibles. A new report from the Kaiser Family Foundation, “Proposed Models to Integrate Medicare and Medicaid Benefits for Dual Eligibles,” provides an overview of plans in the 15 states that received design contracts of up to $1 million in April 2011 from the Center for Medicare and Medicaid Innovation (CMMI) and the Medicare-Medicaid Coordination Office (MMCO). The MMCO, created by the Affordable Care Act (ACA), aims to better align and coordinate Medicare and Medicaid coverage for dual eligibles, a group that accounts for 15 percent of the Medicaid population but 39 percent of Medicaid spending, in part due to the population’s high health needs.

Some states prefer to incorporate duals into ongoing implementation of managed care solutions. For example, Colorado plans to include all state Medicaid recipients in its Accountable Care Collaborative Program, which will emphasize medical homes and primary care case management. Other states, such as Massachusetts, Michigan and South Carolina, propose using a combination of managed care organizations, accountable care organizations and medical homes to integrate care for duals. North Carolina plans to build upon the existing Community Care of North Carolina program (CCNC), which includes primary care medical homes.

In Medicare Rights’ experience, advocates and policymakers should look beyond the four corners of a single proposal to understand the trajectory of a policy’s implementation. Though New York State’s duals proposal includes a variety of options, the state’s larger programmatic goal of transitioning all Medicaid recipients into managed care plans has shaped its planning. New Yorkis currently transitioning beneficiaries who receive 120 days of community-based care into managed long-term care plans, and the state has indicated that this effort will inform future decisions regarding the dual-eligible population.

While the integration of benefits for dual eligibles creates opportunities to improve patient experience while promoting efficiency and cost savings, there are still some outstanding issues that states may need to address as they move forward with coordination plans. Five states have not yet decided whether enrollment for duals will be voluntary or mandatory, and in two states, enrollment would be mandatory for a significant portion of duals. Also, no state has suggested coordinating the divergent Medicare and Medicaid grievance and appeals processes, which could become an obstacle for some duals who attempt to receive care. Beneficiary protections such as these are critical components of integrated delivery of quality care. States must ensure that their final plans remove inefficiencies that prevent the poorest and sickest residents from easily accessing health care.

Read the Kaiser report.