{"id":508,"date":"2019-05-02T00:00:00","date_gmt":"2019-05-02T00:00:00","guid":{"rendered":"https:\/\/eccovia.com\/index.php\/2019\/05\/02\/cms-opens-testing-out-integrated-care-models-for-dual-eligibility-up-to-states\/"},"modified":"2024-03-11T14:23:49","modified_gmt":"2024-03-11T14:23:49","slug":"cms-opens-testing-out-integrated-care-models-for-dual-eligibility-up-to-states","status":"publish","type":"post","link":"https:\/\/eccovia.com\/blog\/cms-opens-testing-out-integrated-care-models-for-dual-eligibility-up-to-states\/","title":{"rendered":"CMS Opens Testing Out Integrated Care Models for Dual Eligibility up to States"},"content":{"rendered":"
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On April 24, the federal government issued a letter to Medicaid directors announcing new opportunities to test integrated care models for dual-eligible individuals (Medicare and Medicaid). Twelve million Americans use services from both Medicare and Medicaid, and many of these have complex healthcare issues, including multiple chronic conditions, and experience socioeconomic risk factors that can lead to poor outcomes.<\/p>\n

Many dual-eligible individuals find it challenging to access care because Medicare and Medicaid operate in silos, not providing integrated, easily navigable services. In the words of Centers for Medicare & Medicaid Services Administrator Seema Verma, \u201cLess than 10% of dually eligible individuals are enrolled in any form of care that integrates Medicare and Medicaid services, and instead have to navigate disconnected delivery and payment systems. This lack of coordination can lead to fragmented care for individuals, misaligned incentives for payers and providers, and administrative inefficiencies and programmatic burdens for all. We must do better, and CMS is taking action.\u201d<\/p>\n

To this end, CMS invited states to come up with new ways to integrate care for all dual-eligibles or specific subsets, like people living in rural areas. The agency expressed its interest in concepts that reduce spending in the Medicaid and Medicare programs while increasing access to coordinated care, improving quality, and preserving patients\u2019 access to all covered Medicare benefits.<\/p>\n

The invitation to state Medicaid agencies is part of the CMS\u2019 broader commitment to improve care for dual-eligible individuals. CMS aims to bring shared accountability for creating a more seamless experience for beneficiaries and providers across Medicare and Medicaid while ensuring that the program is pointed toward lower cost and better outcomes.<\/p>\n

The letter to the State Medicaid Directors included three models:<\/p>\n