New Flexibilities Expand and Promote Partnerships

A top priority for this Administration is improving the quality and lowering the cost of care for the millions of Americans enrolled in both Medicare and Medicaid (known as “dual eligibles” or Medicare-Medicaid enrollees). The Affordable Care Act created the new CMS Medicare-Medicaid Coordination Office to improve the coordination and quality of care for Medicare-Medicaid enrollees. Through our work and with our State partners, our efforts are advancing to the next level.

Medicare-Medicaid enrollees are low-income seniors and people with disabilities. Although most have complex care needs, too often their care is fragmented, resulting in poor health outcomes and increased costs. When their primary care doctors and specialists coordinate their care, including their long-term care services and supports, these individuals get better health care at a reduced cost.

In July, the Medicare-Medicaid Coordination Office announced a new opportunity for States to participate in demonstration projects that will help improve the quality of care for Medicare-Medicaid enrollees. These approaches provide States the opportunity to share in reduced costs that result from improved quality.

We’re pleased to report that 37 States and the District of Columbia have indicated interest in exploring these demonstrations in their states. Across the country States are moving forward and proposing new ways to better serve their Medicare-Medicaid enrollees. These innovative initiatives vary regionally and in their approach, ranging from using health homes that provide total care management to expanding existing programs to meet all of an individual’s needs by incorporating behavioral health and long-term supports and services, as well as making current coordinated care models available to new populations, such as individuals with long-term care needs or those with serious and persistent mental illness. Two examples of these new approaches are:

Massachusetts is developing an innovative approach to ensure that enrollees under age 65 have one organization responsible for coordinating their medical and non-medical needs. In addition to integrating all Medicare and Medicaid services, enrollees would have new access to enhanced behavioral health services and community support services not normally available to this population in a traditional fee-for-service model. These services will help beneficiaries in the community and avoid unnecessary hospitalizations.

Oklahoma is expanding its efforts to coordinate care to better serve Medicare-Medicaid enrollees Statewide. Building on existing models, with newfound access to Medicare data and an opportunity to share in savings from care management investments, the State seeks to develop a person-centered approach that provides for the totality of an individual’s needs, through coordination of primary, acute, and behavioral health care as well as prescription drugs and long-term services and supports.

Over the next several months, we will be working closely with the States interested in further developing their approaches and will serve as a resource for any State interested in improving care for their Medicare-Medicaid enrollees. These models provide States and the Federal government with new flexibilities and pathways to make Medicare and Medicaid stronger. Together, with our State partners, we will continue our commitment to caring for the most vulnerable individuals we serve.