Massachusetts is First State to Receive CMS Approval for Medicaid-Medicare Care Coordination Plan

by Rebecca Farley on August 30, 2012

Massachusetts will become the first state to implement a demonstration project aimed at better coordinating healthcare services for individuals who are dually eligible for Medicaid and Medicare, state and federal officials announced last week.

The coordinated care demonstration projects were made possible by the Affordable Care Act; 14 other states have also been selected to participate and have submitted or are planning their proposed projects. Collectively, their programs will serve up to 2 million enrollees. The demonstration projects are designed to test two different payment models with the ultimate goal of better aligning financing models with the provision of integrated primary, acute, behavioral health and long term services and supports.

Massachusetts’ pilot program will cover about 111,000 disabled adults who are dually enrolled in Medicaid and Medicare. The state has selected a capitated financial model to fund enrollees’ services, in which integrated care organizations will receive a prospective payment to deliver care to these patients. The demonstration program will enable the state to offer expanded services for enrollees, such as additional dental care, vision, and behavioral health services. Care teams will be made up of a primary care provider, a care coordinator, and a long-term services coordinator.

Massachusetts already begun soliciting bids from integrated care organizations and expects to begin accepting enrollments in the pilot program by January 2013. Eligible beneficiaries who do not enroll on their own will be automatically placed in an ICO. However, Massachusetts has said they will have the option to opt out or to switch to an alternate plan if they are not satisfied with the plan into which they are placed.

The Massachusetts proposal is available for viewing online.

 

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