CMS’ dual-el­i­gi­ble demon­stra­tion up­date due

Modern Healthcare - - THE WEEK AHEAD - —Vir­gil Dick­son

States may re­ceive some in­sight from the CMS this week on the am­bi­tious fed­eral demon­stra­tion aimed at im­prov­ing co­or­di­na­tion of benefits and care for the nearly 9 mil­lion low­in­come, el­derly and dis­abled Amer­i­cans who are du­ally el­i­gi­ble for Med­i­caid and Medi­care.

Dur­ing the Med­i­caid and CHIP Pay­ment and Ac­cess Com­mis­sion meet­ing Thurs­day, Tim En­gel­hardt, direc­tor of the CMS’ Medi­care-Med­i­caid Co­or­di­na­tion Of­fice, will pro­vide an up­date on fed­eral-state ini­tia­tives tak­ing place un­der the Fi­nan­cial Align­ment Ini­tia­tive. The com­mis­sion is sched­uled to re­lease find­ings from fo­cus groups of dual-el­i­gi­ble en­rollees par­tic­i­pat­ing in the demon­stra­tions in Cal­i­for­nia, Mas­sachusetts and Ohio.

Eleven states are run­ning dual-eligi- ble demon­stra­tions in which man­aged-care plans pro­vide the full range of Med­i­caid and Medi­care benefits and ser­vices for this vul­ner­a­ble, ex­pen­sive pa­tient pop­u­la­tion. Last year, the Na­tional As­so­ci­a­tion of Med­i­caid Di­rec­tors sent a let­ter to the CMS ask­ing about the un­cer­tain fu­ture of the demon­stra­tions. “States are ea­ger to un­der­stand CMS’ long-range work plan for the demon­stra­tions,” the group wrote. The CMS replied in Jan­uary that it was “too early to make any con­clu­sions about the suc­cess of the demon­stra­tions.”

Pa­tient ad­vo­cates and health in­sur­ance plans in­volved in the demon­stra­tions say it’s been tough to achieve cost-sav­ing goals be­cause ben­e­fi­cia­ries’ par­tic­i­pa­tion is op­tional and many are opt­ing out. Of the 1.7 mil­lion peo­ple el­i­gi­ble to par­tic­i­pate in the 11 states, 343,355 had signed up as of April 1, ac­cord­ing to Com­mu­nity Cat­a­lyst in Mas­sachusetts.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.