Today, the Centers for Medicare & Medicaid Services (CMS) sent a
letter to state Medicaid directors that outlines both existing and new
opportunities for states to better serve individuals dually-eligible for
Medicare and Medicaid. The letter highlights opportunities to implement new
developments with Managed Care, use Medicare data to inform care
coordination and program integrity initiatives, and reduce administrative
burden for dually-eligible beneficiaries and the providers who serve them.
There are over 12 million Americans enrolled in both the Medicaid and
Medicare programs. The programs continue to have different rules for
eligibility, covered benefits, and payment, and operate as separate and
distinct. Dually-eligible individuals experience high rates of chronic
illness, with many having multiple chronic conditions and/or social risk
factors. Forty one percent of dually-eligible beneficiaries have at least
one mental health diagnosis, and about half use Long Term Services and
Supports (LTSS).
The letter describes ten opportunities – none of which require complex
demonstrations or Medicare waivers – to better serve individuals
dually-eligible for Medicare and Medicaid. CMS often receives feedback from
states interested in how Medicare and Medicaid can work better together. A
number of states have already launched ambitious initiatives to better
serve dually-eligible individuals, including those states that are testing
demonstrations, such as the models under the Medicare-Medicaid Financial
Alignment Initiative, in collaboration with CMS. We will be outlining new
demonstration-related opportunities for these and other states in the
coming months.
The State Medicaid Director Letter is available on Medicaid.gov: https://www.medicaid.gov/federal-policy-Guidance/index.html
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