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CMS Invites States to Shake Up Dual Eligible Benefits Delivery

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CMS Invites States to Shake Up Dual Eligible Benefits Delivery

April 29, 2019

The Department of Health and Human Services (HHS) and its agency the Centers for Medicare and Medicaid Services (CMS) wrote a letter to state Medicaid directors and to governors encouraging them to consider three models that seek to integrate care for dual eligible populations (meaning eligible for both Medicare and Medicaid benefits).  The letter also refers to a previous correspondence to Medicaid directors on the topic of dual eligible populations. The Administration has consistently stated it wished to reduce the costs of care for dual eligible populations, who are more medically complex, and of Medicaid in general, while fostering state flexibility and innovation. These three models reflect that approach.

The letters inform states of three options, two of which appear to be expansions of existing demonstration grants under the Financial Alignment Initiative:

  • Opportunity 1 is tailored for states with “capitated financial alignment demonstration programs” (also known as the Financial Alignment Initiative). These states are: California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, and Texas. The option is also open to states who do not have these models but would like to pursue them.
  •  Opportunity 2 is tailored for states with managed fee-for-service models under the Financial Alignment Initiative (Washington, Colorado).
  • Opportunity 3 is an invitation to states interested “in developing new, state-specific models to integrate care for dually eligible individuals”. CMS invites states to “to come to us with your ideas, concept papers, and/or proposals.”

ANCOR is studying these proposals will share more information as we learn it. Our initial read has been that our partners and experts in the field are generally supportive of this latest proposal.