Kaiser Family Foundation Survey on State Medicaid Managed Care ...

(e.g., need to credential Adult <strong>Family</strong> Homes and Boarding Homes); lack of support from Area Agencieson Aging (AAAs); and difficulty contacting beneficiaries for potential enrollment.Medicaid managed care initiatives for dual eligiblesTwenty-five states reported enrollment of dual eligibles in (non-PACE) Medicaid managed carearrangements, on either a voluntary or mandatory basis. Nearly nine million Medicaid beneficiaries aredual eligibles – low-income seniors and younger persons with disabilities who are enrolled in bothMedicare and Medicaid. Dual eligibles are among the sickest and poorest Medicare beneficiaries, andthey account for almost 40 percent of total Medicaid spending although they comprise just 15 percentof Medicaid enrollees. State policymakers are eager to find ways to better control costs and improvecare for this population, including through managed care approaches that integrate medical and, insome cases, long-term services, and also through models that integrate Medicaid and Medicare servicedelivery and payment.Overall, 25 states reported enrollment of dual eligibles in non-PACE Medicaid managed carearrangements, on either a voluntary or mandatory basis. In some of the 25 states, dual eligibles areenrolled in comprehensive managed care – MCOs or PCCM programs; in other states, dual eligibles areenrolled in non-comprehensive PHPs for specific categories of service, such as mental health care orlong-term services and supports, but remain in fee-for-service or in other managed care arrangementsfor all other Medicaid-covered services. Table 13 summarizes Medicaid managed care enrollmentarrangements for dual eligibles in the 25 states.StateArizonaCaliforniaColoradoDCFloridaGeorgiaHawaiiIdahoIowaTable 13: Medicaid Managed Care Enrollment Arrangements for Dual Eligibles (non-PACE)Description of ArrangementDual eligibles must enroll in the ALTCS (long-term care managed care program). All ALTCS MCOs inMaricopa County must be a Medicare Advantage Plan or a Medicare Advantage SNP.Enrollment of dual eligibles is mandatory in County-Organized Health Systems. Voluntaryenrollment in Two-Plan and Geographic Managed Care counties under the following rules: 1) Medi-Cal beneficiary must be enrolled in a Medi-Cal MCO; 2) the Medicare Advantage/Special NeedsPlan (MA/SNP) that the beneficiary chooses must be the Medi-Cal MCO in which the member iscurrently enrolled or its plan partner in the county; 3) the member will be disenrolled from theMedi-Cal MCO and placed into fee-for-service if the beneficiary chooses a MA/SNP that is notassociated with the Medi-Cal MCO.Dual eligibles may voluntarily enroll in Denver Health (MCO), the Colorado Regional IntegratedCare Collaborative (EPCCM), and Rocky Mountain Health Care (PHP).Dual eligibles are enrolled in the non-emergency transportation PHP on a mandatory basis.Dual eligibles may voluntarily enroll in MCOs (including the Nursing Home Diversion Programplans) unless otherwise excluded.Dual eligibles may voluntarily participate in the Service Options Using Resources in a CommunityEnvironment (SOURCE) – an enhanced PCCM program serving certain frail elderly and disabledbeneficiaries to improve the health outcomes of persons with chronic health conditions by linkingprimary medical care with home and community-based services. The program builds on the state’sPCCM program, Georgia Better Health Care Program (GBHC).Dual eligibles are enrolled in QExA (QUEST Expanded Access) on a mandatory basis.Dual eligibles may voluntarily enroll in the Medicare Medicaid Coordinated Plans (noncomprehensivePHPs) offered through Blue Cross and United Healthcare.Dual eligibles enroll in the state’s behavioral health PHP.continued45