Published on 28 December 2012
Integrated Care for Medicare-Medicaid Dual Eligibles: CMS Grants for Implementation of State Demonstrations

To support demonstrations to integrate Medicare and Medicaid for dual eligibles, the Centers for Medicare and Medicaid Services (CMS) offering state Medicaid agencies grants of up to $15 million each.  The funds are for implementation of CMS approved designs to integrate care for Medicare-Medicaid enrollees.  Most of the state demonstrations involve the use of integrated health plans that will compete to provide most or all Medicaid and Medicare services for the state’s full-benefit dual eligibles.  Other models include managed fee-for-service with shared savings.

Grants funds are only available to the 15 states that received a design contract for a Demonstration to Integrate Care for Dual Eligible Individuals and have a signed Memorandum of Understanding (MOU) with CMS to implement their demonstration design.  An MOU must be in place before a state receives the implementation grant funds.

The 15 states with design contracts with CMS and therefore eligible to apply to a grant are California, Colorado, Connecticut, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington, and Wisconsin.  Some of these have proposed more than one approach to integrating Medicare and Medicaid financing and care delivery.  So far three states – Massachusetts, Ohio, and Washington – have a demo MOU with CMS.

The CMS grants – made available through the Medicare-Medicaid Coordination Office and Center for Medicare and Medicaid Innovation (CMMI) using Affordable Care Act (ACA) funds – may be used to support a wide range of demo implementation activities by state Medicaid agencies, such as:

  • Beneficiary and provider outreach and education.
  • Participant ombudsmen activities to support individual advocacy and independent systematic oversight with a focus on compliance with principles of community integration, independent living, and person-centered care in the home and community based care context.
  • Independent enrollment broker.
  • Information and assistance for beneficiaries.
  • Stakeholder engagement.
  • Provider training.
  • Ongoing monitoring of health plans, care coordination entities, and providers, including network adequacy.
  • Improvement to and execution of grievances and appeals.
  • Ongoing processes to confirm network adequacy.
  • Tracking claims and quality data.
  • Actuarial analysis and rate-setting.
  • State-level information technology systems modifications to support beneficiary enrollment and data collection and reporting.
  • Evaluation activities that do not duplicate those performed by the CMS’ independent evaluator for the demonstration.

To read the CMS grant announcement, click here (PDF).

About Author

An expert on Medicaid, Medicare, and health reform, Kip Piper, MA, FACHE, is a consultant, speaker, and author. Kip Piper advises health plans, hospitals and health systems, states, and pharma, biotech, medical device, HIT, and investment firms. With 30 years’ experience, Kip is a senior consultant with Sellers Dorsey, top specialists in Medicaid and health reform. He is also a senior advisor with Fleishman-Hillard and TogoRun. For more, visit KipPiper.com. Follow on Twitter @KipPiper, Google +, Facebook and connect on LinkedIn.

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