New Kaiser Report Compares States’ Plans for Duals Integration

The Kaiser Family Foundation (KFF) recently released a report comparing five states’ memoranda of understanding (MOUs) with the Centers for Medicare & Medicaid Services (CMS) to test integration demonstrations for people who are dually eligible for Medicare and Medicaid. CMS has finalized MOUs with California, Illinois, Massachusetts, Ohio (capitated models) and Washington (fee-for-service model) to test new ways of integrating care and aligning financing for dual eligibles. The KFF report compares the MOUs in the following categories:

Target population: According to the KFF report, the demonstrations in the five states will include nearly 843,000 dual eligible beneficiaries. The Massachusetts demonstration targets non-elderly dual eligibles, while California, Illinois and Ohio include all dual eligibles, regardless of age.

Enrollment: All states utilize some form of “passive” or “automatic” enrollment in their demonstrations. The Illinois, Massachusetts and Ohio demonstrations begin with a voluntary enrollment period. California will implement a voluntary enrollment period in Los Angeles County, but elsewhere in California, beneficiaries will only be enrolled automatically.

Care delivery model: California, Illinois, Massachusetts and Ohio will use managed care plans to coordinate care for dual eligible beneficiaries as part of a capitated model—the plans will receive one payment to coordinate Medicare and Medicaid services for all enrolled beneficiaries. Washington will use health home networks to coordinate Medicare and Medicaid services, and the health homes will be financed using a fee-for-service model.

The KFF report also compares the MOUs in the categories of benefits, financing and ombudsman programs. Many aspects of the demonstrations are currently being developed and are not detailed in the MOUs, including how beneficiaries will be notified, counseled and enrolled into the new Medicare-Medicaid plans, and how CMS and the states will monitor, oversee and evaluate the demonstrations and the private plans involved.

New York State is also participating in the CMS demonstration. New York has not finalized its MOU with CMS, and the Medicare Rights Center continues to advocate on

Read the KFF report.