The Centers for Medicare and Medicaid Services plans to retool the Medicare Advantage program to improve the patient experience for people eligible for both Medicare and Medicaid, an agency official said during AHIP's National Conference on Medicare, Medicaid and Dual Eligibles Online Tuesday.
The agency wants to build on the lessons learned from Medicare-Medicaid Plans participating in its Financial Alignment Initiative by incorporating them into the Medicare Advantage program, said Tim Engelhardt, director of CMS' Medicare-Medicaid Coordination Office. CMS could announce the changes as soon as this fall, he said.
"It's really time for us to focus on bringing more of the successful elements to greater scale through Medicare Advantage," Engelhardt said. "Stay tuned."
CMS will continue to support Medicare-Medicaid Plans after it modifies the Medicare Advantage program to include some of their features, Engelhardt said.
Medicare-Medicaid Plans are private health plans designed to provide integrated, coordinated Medicare and Medicaid benefits to Medicare beneficiaries eligible for both programs. They only serve full-benefit dual-eligible Medicare beneficiaries, unlike Dual Eligible Special Needs Plans. Under Medicare-Medicaid Plans, CMS and states pay insurers a prospective capitation payment to provide health coverage for dual-eligibles.
The program has had uneven results on cost and quality to date, according to a report the Alliance for Health Policy issued in April. Although enrollees used emergency departments less and hospitalizations were down, the effect on volumes of other services, such as nursing home admissions, has been mixed. Some beneficiaries reported disappointing or nonexistent interactions with care coordinators. And the overall impact on costs is unclear.
Nearly 419,000 people are enrolled in Medicare-Medicaid Plans in nine states as of this month, according to CMS's Integrated Care Resource Center. But enrollment among eligible Medicare beneficiaries differed significantly among those states, the Medicaid and CHIP Payment and Access Commission reported in August 2020.
"Only about 29% of individuals eligible to participate in [Financial Alignment Initiative] capitated models were enrolled in them. Participation varied by state, from a high of about 67% in Ohio to a low of about 4% in New York," the report said.
Congress mandated that CMS test the Financial Alignment Initiative, including Medicare-Medicaid Plans, in the Affordable Care Act.