Twenty-six states have submitted proposals to CMS to reform how they take care of dual eligible patients, according to a report from the Kaiser Commission on Medicaid and the Uninsured (pdf).
Dual eligibles are those who receive health coverage through both Medicare and Medicaid, and they are generally considered to be the sickest people within either program. Because this is a high-cost, high-risk group, CMS has proposed two models to improve dual eligible care: one involving capitation and another involving managed fee-for-service.
The Kaiser report looks at the 26 states moving ahead with dual eligible reform programs, pending CMS approval. Here are some key findings from the Kaiser report:
• Eighteen states will test the capitation model, five states will try the managed FFS model and three states will test both.
• Half of the states proposed sharing savings from these models with providers and/or health plans.
• Twenty-three states plan to enroll dual eligible patients passively into their demonstration plans, meaning dual eligibles will be automatically placed in the demonstrations but may decide to opt out.
• Most states (24) plan to implement their dual eligible demonstrations in 2013 or 2014, while two states hope to implement part of their demonstration by the end of this year.
Dual eligibles are those who receive health coverage through both Medicare and Medicaid, and they are generally considered to be the sickest people within either program. Because this is a high-cost, high-risk group, CMS has proposed two models to improve dual eligible care: one involving capitation and another involving managed fee-for-service.
The Kaiser report looks at the 26 states moving ahead with dual eligible reform programs, pending CMS approval. Here are some key findings from the Kaiser report:
• Eighteen states will test the capitation model, five states will try the managed FFS model and three states will test both.
• Half of the states proposed sharing savings from these models with providers and/or health plans.
• Twenty-three states plan to enroll dual eligible patients passively into their demonstration plans, meaning dual eligibles will be automatically placed in the demonstrations but may decide to opt out.
• Most states (24) plan to implement their dual eligible demonstrations in 2013 or 2014, while two states hope to implement part of their demonstration by the end of this year.
More Articles on Dual Eligibles:
Study Links Physician Group Practice Demo to Big Savings for Dual Eligibles
Report: Managed Care Transition Cumbersome for California Medicaid Seniors
Massachusetts Becomes First State to Participate in CMS Dual Eligible Demonstration