The Facilities for Medicare and Medicaid Providers plans to retool the Medicare Benefit program to enhance the affected person expertise for folks eligible for each Medicare and Medicaid, an company official stated throughout AHIP’s Nationwide Convention on Medicare, Medicaid and Twin Eligibles On-line Tuesday.
The company needs to construct on the teachings realized from Medicare-Medicaid Plans taking part in its Monetary Alignment Initiative by incorporating them into the Medicare Benefit program, stated Tim Engelhardt, director of CMS’ Medicare-Medicaid Coordination Workplace. CMS might announce the modifications as quickly as this fall, he stated.
“It is actually time for us to concentrate on bringing extra of the profitable parts to higher scale by Medicare Benefit,” Engelhardt stated. “Keep tuned.”
CMS will proceed to help Medicare-Medicaid Plans after it modifies the Medicare Benefit program to incorporate a few of their options, Engelhardt stated.
Medicare-Medicaid Plans are non-public well being plans designed to supply built-in, coordinated Medicare and Medicaid advantages to Medicare beneficiaries eligible for each packages. They solely serve full-benefit dual-eligible Medicare beneficiaries, in contrast to Twin Eligible Particular Wants Plans. Beneath Medicare-Medicaid Plans, CMS and states pay insurers a potential capitation cost to supply well being protection for dual-eligibles.
This system has had uneven outcomes on price and high quality thus far, in line with a report the Alliance for Well being Coverage issued in April. Though enrollees used emergency departments much less and hospitalizations have been down, the impact on volumes of different companies, similar to nursing house admissions, has been blended. Some beneficiaries reported disappointing or nonexistent interactions with care coordinators. And the general impression on prices is unclear.
Practically 419,000 individuals are enrolled in Medicare-Medicaid Plans in 9 states as of this month, in line with CMS’s Built-in Care Useful resource Heart. However enrollment amongst eligible Medicare beneficiaries differed considerably amongst these states, the Medicaid and CHIP Cost and Entry Fee reported in August 2020.
“Solely about 29% of people eligible to take part in [Financial Alignment Initiative] capitated fashions have been enrolled in them. Participation assorted by state, from a excessive of about 67% in Ohio to a low of about 4% in New York,” the report stated.
Congress mandated that CMS check the Monetary Alignment Initiative, together with Medicare-Medicaid Plans, within the Reasonably priced Care Act.