Dual Eligibles

This report summarizes the Medicare Parts A & B actuarial savings analysis of the Washington managed fee-for-service (MFFS) demonstration for 2015 and 2016. The Washington Health Home MFFS demonstration aims to improve service quality and integration while reducing costs of care for high-risk, high-cost dually eligible beneficiaries. For 2015, Washington demonstrated a final gross Medicare savings of $30 million. The preliminary gross Medicare savings for 2016 are $42 million.

While faced with new challenges, reduced budgets, and growing populations requiring more services, states are stronger than ever, and the work they do is more effective than ever in reaching individuals and addressing their needs. The National Home and Community Based Services (HCBS) Conference 2018 highlights these achievements, allowing states to share best practices, present unique partnerships, and recognize the work of their peers.

To understand both the needs of people who use long-term services and supports (LTSS) through Medicare and Medicaid coverage and ways to apply quality measurement to this population, the National Committee for Quality Assurance (NCQA), supported by The SCAN Foundation, developed a roadmap for evaluating the quality of integrated care for dual eligibles.

CMS regularly reports data on health plan enrollment, quality, and compliance that states can use to monitor the performance of the Medicare Advantage Dual Eligible Special Needs Plans (D-SNPs) they contract with to serve Medicare-Medicaid enrollees. This technical assistance tool shows how states can use these data to create tables, graphs, and figures and interpret their meaning in order to assess D-SNP performance.

The CMS Medicare-Medicaid Coordination Office (MMCO) regularly reports data on Medicare-Medicaid enrollee demographics, service utilization, spending, and other characteristics that can give states a more comprehensive view of this population. This tool shows states how to use these data to create tables, graphs, and figures and interpret their meaning for a wider audience of stakeholders.

The Center for Health Care Strategies (CHCS) and Manatt Health has developed a new toolkit that provides a targeted menu of long-term services and supports (LTSS) reform strategies adopted by state innovators that may be replicated by other states. The toolkit identifies concrete policy strategies, operational steps, and federal and state authorities that states have used to advance their LTSS reforms.

For individuals who receive services from both Medicare and Medicaid, care is often fragmented across a wide array of medical, behavioral health, and long-term care providers. Medicare and Medicaid offer otherwise uncoordinated systems of care with different eligibility criteria, benefits, provider networks, and enrollment processes. This issue brief describes key features of effective integrated care programs and presents top policy considerations driving state investment in these programs.

This report reviews federal health and housing policies, noting the barriers created that seniors with clinically-driven housing insecurity must navigate. It also reviews a series of initiatives that ACAP members are undertaking to address housing as a social determinant for this vulnerable population, with examples from California, Ohio, and North Carolina.

The AAHD Health Promotion Resource Center for People with Disabilities is intended to provide visitors with current and valuable information about multiple aspects of health promotion and wellness for people with disabilities.

This brief from the SCAN Foundation summarizes lessons learned and offers recommendations for improving integrated systems of care for people with Medicare and Medicaid, also known as dually eligible individuals. The brief draws from three years of California’s Cal MediConnect evaluation results.