Dual Eligibles

Washington is the first state to enter into a MOU to participate in the new managed-fee-for-service Demonstration to integrate the service delivery across primary, acute, prescription drugs, behavioral health and LTSS. This document details the principles under which CMS and the State plan to implement and operate the Demonstration. It also outlines the activities CMS and the State plan to conduct in preparation for implementation of the Demonstration and initiate the Demonstration.

Massachusetts is the first state to finalize a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) to test CMS's capitated financial alignment model for beneficiaries who are dually eligible for Medicare and Medicaid. This policy brief summarizes the MOU terms in the several key areas, including enrollment, care delivery model, benefits, financing, beneficiary protections and monitoring and evaluation.

This paper examines the contents of the 26 states’ proposals, which intent to test on two models related to financing dual eligible beneficiaries, in the areas of target population, implementation date, enrollment, financing, benefits, beneficiary protections, stakeholder engagement, and demonstration evaluation as set out in the states’ initial submission to CMS. Negotiations between CMS and the states are ongoing and are likely to result in some changes from the states’ initial proposals.

This document provides an overview of the joint efforts of states and the CMS to develop more integrated ways of paying for and delivering health care to the 9 million people who are eligible for both the Medicare and Medicaid programs. As an outgrowth of the Affordable Care Act, CMS is reviewing proposals from states to test two new models to align Medicare and Medicaid benefits and financing for dual eligible beneficiaries with the goal of delivering better coordinated care and reducing costs.

The coordination of Medicare and Medicaid benefits and services for dually eligible enrollees has been a longstanding policy challenge. Several provisions of the Affordable Care Act (ACA) attempt to address this lack of coordination. This paper reviews the major changes under the ACA directed at care coordination for the dually eligible population and then concludes with a discussion of the continuing legislative and legal challenges in integrating care for the dually eligible.

Centers for Medicare and Medicaid Services (CMS) has provided funding and technical assistance to states to develop state plans' to coordinate care for dual eligibles, persons eligible for both Medicare and Medicaid. This chart shows the status of those states selected for the Dual Demonstration grants, the model chosen, and target implementation. It also includes links to each state's plan.

Today there are over 9 million Medicare-Medicaid enrollees in the United States. To provide a greater understanding of the Medicare-Medicaid enrollee population, Centers for Medicare & Medicaid Services has put together individual State profiles that examine the demographic characteristics, utilization, and spending patterns of Medicare-Medicaid enrollees and the programs that serve them in each State. Also review the National Summary Profile.

As state and federal policymakers move to develop and test integrated care models for people dually eligible for Medicare and Medicaid, two new Kaiser Family Foundation articles in the June 2012 issue of Health Affairs highlight the diverse needs and challenges facing these 9 million beneficiaries, describe their current care arrangements, and raise issues to consider for proposed reforms aimed at better coordinating their care and reducing health care spending.

An Accountable Care Organization (ACO) is a provider-run organization in which the participating providers are collectively responsible for the care of an enrolled population. This brief examines the existing Medicaid payment and care delivery landscape in states undertaking Medicaid ACO initiatives to gain insights into how ACOs fit into states’ Medicaid programs, and to identify important differences between Medicaid ACOs and ACOs in Medicare and the private insurance market.

Section 1115 waivers provide states an avenue to test new approaches in Medicaid that differ from federal program rules. Waivers can provide states significant flexibility in how they operate programs and can have a significant impact on program financing. As such, waivers have important implications for beneficiaries, providers, and states. This brief provides an overview of Section 1115 waiver authority, the waiver approval process, and recent waiver activity and discusses the implications.