Today, the Centers for Medicare & Medicaid Services (CMS) sent a
letter to State Medicaid Directors inviting states to partner with CMS to
test innovative approaches to better serve those who are dually eligible
for Medicare and Medicaid. Many of the 12 million dually eligible
beneficiaries have complex healthcare issues, including multiple chronic
conditions, and often have socioeconomic risk factors that can lead to poor
outcomes. Today’s letter opens new ways to address those complex needs,
align incentives, encourage marketplace innovation through the private
sector, lower costs, and reduce administrative burdens for dually eligible
individuals and the providers who serve them.
As one of CMS’ Strategic Priorities for 2019, we are redoubling efforts
to better serve older adults and people with disabilities dually eligible
for Medicaid and Medicare. Our goal is to bring shared accountability for
creating a more seamless experience for beneficiaries and providers across
the two programs, while ensuring that the program’s incentives are aligned
and pointed toward lower cost and better outcomes.
Approaches discussed in the State Medicaid Directors letter include:
- The Capitated Financial Alignment Model. Through a joint
contract with CMS, states and health plans, this model option creates
a way to provide the full array of Medicare and Medicaid services for
enrollees for a set capitated dollar amount.
- Managed Fee-for-Service Model. This model is a
partnership between CMS and the participating state and allows states
to share in Medicare savings from innovations where services are
covered on a fee-for-service (FFS) basis.
- State-Specific Models. CMS is open to
partnering with states on testing new state-developed models to better
serve dually eligible individuals and invite states to come to us with
ideas, concept papers, and/or proposals.
Today’s letter complements a State Medicaid Director Letter CMS released in December
2018 that highlighted ten opportunities to improve care for dually
eligible individuals, including using Medicare data to inform care
coordination and program integrity initiatives, and reducing administrative
burden for dually eligible individuals and the providers who serve them.
The opportunities in today’s letter, together with the Primary Cares Initiative, present an array of options
for transforming care delivery.
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