State Projects to Align Financing for Dual Eligible Patients

Six states will launch projects this year to integrate care and align financing for patients who are eligible for both Medicare and Medicaid, according to a report from The Kaiser Commission on Medicaid and the Uninsured.

CMS has finalized memoranda of understanding with California, Virginia, Ohio, Massachusetts and Illinois to test a capitated model, according to the report. Washington has received approval to test a managed fee-for-service model.

Under the capitated financial alignment model, the baseline payment for Medicare Parts A and B will be determined using a combination of Medicare Advantage benchmarks and Medicare fee-for-service standardized county rates weighted by whether enrollees transitioning into the project were previously enrolled in a Medicare Advantage plan or a Medicare fee-for-service plan.

Under the Washington project model, providers will keep receiving fee-for-service payments for services covered by Medicare and Medicaid.

Dual eligible beneficiaries are often the sickest and poorest patients covered by either healthcare program, and existing care models typically don't involve much if any coordination between Medicare and Medicaid, according to the report.

CMS will limit enrollment in the demonstration projects to 2 million beneficiaries. The agency has yet to determine details of the projects such as how they will be overseen and evaluated.

More Articles on Medicare and Medicaid Payments:
CMS: Controlling Medicaid "Super-Utilizers" Will Lower Costs
IOM: Healthcare Payments Shouldn't Be Based on Geography
48 States Expected to Start Paying Physicians Higher Medicaid Rates 

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