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

In many states, broader efforts focused on dual eligibles are expanding or getting underway. Twentyonestates reported on plans to expand or modify current programs or initiate new programs focused ondual eligibles, including 15 states that received funding under an ACA initiative, “State Demonstrationsto Integrate Care for Dual Eligible Individuals”. Under this initiative, administered by the new Medicare-Medicaid Coordination Office in CMS, 15 states received up to $1 million each to design new approachesto better coordinate care for dual eligibles and integrate Medicare and Medicaid financing. Although the15 states will not necessarily proceed to implementation, the goal of the design contracts is to identifyand validate delivery system and payment coordination models that could be tested and replicated inother states.More recently, CMS issued guidance to state Medicaid programs in July 2011 on new opportunities toalign Medicare and Medicaid financing that CMS would like to test for full dual eligibles in the 15 statesparticipating in the design contracts, as well as in other interested states. This letter has generated newinterest in dual eligible initiatives in additional states. 21 In addition, CMS is making available MedicarePart A, B, and D data for dual eligibles to support states’ care coordination efforts. 22Twenty-one states reported that they have contracts with Medicare Advantage Special Needs Plans(SNP). Many Medicare beneficiaries receive their care in Medicare managed care plans known asMedicare Advantage plans. Special Needs Plans (SNP) are Medicare Advantage plans that are availableto Medicare beneficiaries who are institutionalized, suffer from a severe or disabling chronic condition,or are dually eligible for both Medicare and Medicaid. Twenty-one states (of 45 responding) reportedthat they contract with a dual eligible SNP to provide coverage to this population. The ACA reauthorizedSNPs through 2013 and extended through 2012 the current moratorium on geographic expansion bydual eligible SNPs that do not also have Medicaid contracts. Beginning in 2013, all dual eligible SNPsoperating in a state must have contracts with the state Medicaid agency.Table 14 summarizes state activity related to Medicaid managed care for dual eligibles and broaderinitiatives for dual eligibles.Table 14: Medicaid Managed Care Activity for Dual EligiblesStateEnrolls dualeligiblesCMS design grant forduals initiativeContracts withMedicare SNPsDual eligible initiativeunder developmentALxARxAZ x xCA x x xCO x x x xCT x xDC xDExcontinued21 CMS Letter to State Medicaid Directors, July 8, 2011. Seehttps://www.cms.gov/smdl/downloads/financial_models_supporting_integrated_care_smd.pdf.22 CMS Medicare-Medicaid Coordination Office - Center for Medicaid, CHIP and <strong>Survey</strong> & CertificationInformational Bulletin, Access to Medicare Data to Coordinate Care for Dual Eligible Beneficiaries, May 11,2011.47