The Centers for Medicare & Medicaid Services (CMS) Federal Coordinated Health Care Office has announced that fifteen states have been selected to design new ways to meet the often complex and costly medical needs of the nation’s lowest-income and chronically ill citizens. CMS is looking to these fifteen states to develop creative ways to provide more efficient and less confusing health care delivery for so-called “dual-eligible” beneficiaries. Funding for this project was provided by the Affordable Care Act.
There are around nine million dual eligible Medicare and Medicaid recipients. While that represents a small percentage of the approximately 100 million people enrolled in the two programs, they account for a disproportionate amount of spending or about $300 billion a year across both programs. For example, dual eligible beneficiaries account for 16 percent of Medicare enrollees but 27 percent of Medicare spending; in the Medicaid program, individuals dually enrolled make up 15 percent of the program but account for 39 percent of costs.
Under the State Demonstrations to Integrate Care for Dual Eligible Individuals, selected states will be awarded up to $1 million each to design strategies for implementing person-centered models that fully coordinate primary, acute, behavioral and long-term supports and services for dual eligible individuals. States will work with their dual-eligible Medicare-Medicaid beneficiaries, their families and other stakeholders to develop their demonstration proposals.
The states selected are: California, Colorado, Connecticut, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington and Wisconsin. In addition to the states receiving these awards, CMS will also be working closely with all states that request assistance in improving care coordination for dual eligible individuals.
Additional information can be found on the CMS website page.