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Contracting Opportunities Begin for Dual Eligible Integrated Care
May 3, 2012
By: Sarah E. Swank
Nine million Americans are eligible for both Medicare and Medicaid. Called "dual eligibles," these individuals account for a disproportionate amount of the spending across both programs. Fifteen states will soon launch programs with funding from the State Demonstrations to Integrate Care for Medicare-Medicaid Enrollees. Under this program, the Medicare/Medicaid Coordination Office and the CMS Innovation Center selected states based on their proposals to improve care delivered to dual eligibles, and a medium or high level of readiness to roll out these programs quickly. These states will receive federal funding to design and implement patient-centered models coordinating care among primary, acute, behavioral and long term care settings and services. States are beginning to reach out to providers to participate in state-specific programs.
The fifteen states selected for this program, with links to their individual state designs, are as follows: (all files below open as PDFs)
- New York
- North Carolina
- South Carolina
Each state will work toward the program goals of eliminating duplicative services, expanding access and improving the lives of dual eligibles, while still lowering the cost to care for this population.
After CMS announced this program in 2010, several states applied for funding in the hope that care coordination for dual eligibles would increase quality and lower costs. CMS finds that dual eligibles comprise 16 percent of Medicare enrollees but account for 27 percent of the spending, while in the Medicaid program dual eligibles make up 15 percent of the program but account for 39 percent of the spending. Programs vary from state to state, with certain states starting services this spring, such as Michigan, while others states have target dates this fall, such as New York and Massachusetts. Those interested in contracting with various states to participate in the program should review individual state requirements to determine applicable contract periods and program parameters.