Medicaid managed care organizations can join direct contracting, CMS says

CMS will allow Medicaid managed care organizations that cover patients dually eligible for Medicare and Medicaid to join its direct contracting model.

CMS said it will allow managed care organizations to participate in global and professional options in its direct contracting model, which offers risk-sharing agreements.

This is the first payment model opportunity that helps Medicaid MCOs coordinate care for beneficiaries who are in both Medicaid managed care and Medicare fee-for-service, CMS said.  

"CMS believes that dually eligible individuals can benefit from more integrated systems of care that meet all of their needs — primary, acute, long-term, behavioral and social — in a high quality, cost-effective manner," CMS said in a news release.

"For too long we have struggled to deliver acceptable outcomes for this vulnerable population, but today's model is a game changer," CMS Administrator Seema Verma said Dec. 17. "It represents a significant step toward addressing these long-standing issues and ensuring they receive the coordinated care they rightfully deserve."  

CMS will start accepting applications for participants next year.


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