The CMS is hoping states will continue in a test to better manage benefits and care for low-income and disabled Americans.
The agency sent a notice on Jan. 19 to Massachusetts, Minnesota and Washington to see if officials in those states would extend pilot programs that aim to better coordinate care for people eligible for both Medicare and Medicaid.
All three states launched their efforts in 2013 and they are all on track to end next year. The agency wants to keep them going through Dec. 31, 2019, so it can better evaluate if their efforts are working. It has given officials until March 1 to respond.
Early reports show that beneficiaries feel their quality of care is improving and noted declines in inpatient admissions.
“The long-term viability of the models we are currently testing depends on whether we are able to measure improvements in quality and overall cost savings,” the CMS said in the letter.
Representatives from each state did not return request for comment.
To date, there are 14 dual demonstrations in 13 states. The efforts, except for Minnesota's, which got permission to create its own unique approach to care for duals, were launched under a program created by the Affordable Care Act. Duals often have chronic conditions and require costly care.
Eleven of these demonstrations, including two in New York, are testing the capitated model, under which they receive a capitated payment combining Medicaid and Medicare funds, minus agreed-upon savings. They then enlist plans to commission the full range of services that a dual often needs, including long-term care. Approximately 364,000 beneficiaries as of Oct. 1, 2016 are in these models.
Two other demonstrations are testing the managed fee-for-service model. As of Sept. 1, 2016, 49,000 beneficiaries are being care for under this model.
Minnesota's unique program has more than 36,000 individuals enrolled. Its does not get one combined payment for duals, instead the CMS allows the state to integrate the administrative functions of both programs.
Overall, there are 11 million individuals that are now dually enrolled in Medicaid and Medicare in the U.S., according to the CMS.
The impetus for the demonstrations was that even though dual-eligible beneficiaries make up only 13% of the population, they account for 40% of total Medicaid spending and 27% of total Medicare spending. Experts say the lack of coordination results in poor quality care and unnecessarily high costs, and that addressing this is one of the biggest opportunities for Medicaid and Medicare savings.
Despite largely originating under the ACA, it is likely that President Donald Trump's administration will want these experiments to continue given Trump's pick for HHS secretary, Rep. Tom Price (R-Ga.), has said his aim is to cut spending in the Medicare and Medicaid program, and these individuals, who tend to be the sickest and poorest in the country, will remain in Medicare and Medicaid whether the ACA is repealed or not.
