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May 2011 St@teside

Alignment Initiative: Streamlining Care for Dual-Eligibles

Dual eligibles represent some of the most chronically ill and costly individuals within Medicare and Medicaid and account for a disproportionate amount of the spending in both programs. Sixteen percent of Medicare enrollees are dual eligible beneficiaries, but account for 27 percent of spending. Likewise, 15 percent of Medicaid enrollees are dual eligibles and account for 39 percent of program spending. Aligning services and providing incentives could prevent cost-shifting, reduce adverse health effects, and improve access to care.

On May 11, the U.S. Department of Health and Human Services (HHS) announced the launch of the Medicare-Medicaid Coordination Office’s Alignment Initiative. The Initiative will be responsible for integrating benefits for individuals who are enrolled in both Medicare and Medicaid, also known as dual eligibles. The Initiative’s first step will be to identify and address conflicting requirements between the programs that can create barriers to providing seamless and cost-effective care. In 2008, there was an estimated 9.2 million low-income Americans eligible for both Medicare and Medicaid; two-thirds were over age 65 and the remaining one-third qualified through a disability.

The Alignment Initiative will provide the Centers for Medicare & Medicaid Services  with the opportunity to coordinate with states, providers, beneficiaries, and their caregivers to improve access, quality, and cost for the care of dual eligibles. The Patient Protection and Affordable Care Act (ACA) created the Federal Coordinated Health Care Office (Section 2602) and charged it with aligning Medicare and Medicaid benefits for this population. Fifteen states will receive up to $1 million in dual eligible funds under the ACA. The 15 states receiving dual eligible grants are California, Colorado, Connecticut, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington, and Wisconsin.

In a notice for public comment, the Initiative has created a full list of areas in which both programs have inconsistent requirements that prevent dual eligibles from receiving seamless, quality care. The areas fall within six categories:

  • Coordinated care
  • Fee-for-Service benefits
  • Prescription drugs
  • Cost sharing
  • Enrollment
  • Appeals

 The Alignment Initiative has posted the notice for public comment in the Federal Register. The notice requests public input on priorities and key goals by July 11, 2011.