States to study integrating care for Medicaid/Medicare consumers

The Center for Health Care Strategies (CHCS) has opened an initiative to fund five states in programs to integrate the financing, delivery, and administration of primary, acute, long-term care, social, and behavioral health services for adults who are eligible for both Medicaid and Medicare (the so-called dual eligibles), as well as those who receive services solely through Medicaid. The program is supported by the Robert Wood Johnson Foundation, with additional funding from Evercare and Schaller Anderson.

Each of the five states chosen through a competitive process (Florida, Minnesota, New Mexico, New York, and Washington) will receive up to $100,000 to fund development of an integrated care model.

"Truly integrated care that connects the financing, delivery, and administration of services across Medicaid and Medicare has tremendous potential for improving quality, coordination, and cost-effectiveness for people with complex health care needs," said CHCS vice president for policy Melanie Bella. "We commend the five participating states for their commitment to innovative approaches to integrating health care services."

More than 7 million low-income Americans who are elderly or have disabilities are eligible for both Medicaid and Medicare. Their health care costs generally are substantial, nearly double those of other adults covered by Medicare and eight times higher than Medicaid spending for children.

CHCS officials said integration is a major challenge since Medicaid and Medicare are each governed by their own delivery, financing, and administrative policies and procedures that result in misaligned benefit structures, opportunities for cost-shifting, and unresolved tensions between federal and state governments. Creation of Special Needs Plans in the Medicare Modernization Act offered significant new opportunities to integrate Medicaid and Medicare coverage for adults who are dually eligible for the two programs.

Ms. Bella said the integrated care program will help states develop the infrastructure necessary to successfully integrate health care services, including administrative simplification between Medicare and Medicaid, rate-setting and risk-adjustment, performance standards and measurement, and contracting with Medicare Advantage Special Needs Plans. Each of the five states is to develop and pilot an integrated care model, which will be evaluated to determine best practices for integrating health care services for people with chronic illnesses and disabilities. She said the five states' demonstration projects will inform a training and technical assistance program to help additional states use resources to more effectively integrate care, and ultimately improve the quality of care, for dual eligibles and other Medicaid consumers with medical and long-term care needs.