Today, the Centers
for Medicare & Medicaid Services (CMS) sent a letter to state Medicaid
directors that outlines both existing and new opportunities for states to
better serve individuals dually-eligible for Medicare and Medicaid. The letter
highlights opportunities to implement new developments with Managed Care, use
Medicare data to inform care coordination and program integrity initiatives,
and reduce administrative burden for dually-eligible beneficiaries and the
providers who serve them.
There are over 12 million Americans enrolled in both the Medicaid and
Medicare programs. The programs continue to have different rules for
eligibility, covered benefits, and payment, and operate as separate and
distinct. Dually-eligible individuals experience high rates of chronic illness,
with many having multiple chronic conditions and/or social risk factors. Forty
one percent of dually-eligible beneficiaries have at least one mental health
diagnosis, and about half use Long Term Services and Supports (LTSS).
The letter describes ten opportunities – none of which require complex
demonstrations or Medicare waivers – to better serve individuals
dually-eligible for Medicare and Medicaid. CMS often receives feedback from
states interested in how Medicare and Medicaid can work better together. A
number of states have already launched ambitious initiatives to better serve
dually-eligible individuals, including those states that are testing
demonstrations, such as the models under the Medicare-Medicaid Financial
Alignment Initiative, in collaboration with CMS. We will be outlining new
demonstration-related opportunities for these and other states in the coming
months.
The State Medicaid Director Letter is available on Medicaid.gov: https://www.medicaid.gov/federal-policy-Guidance/index.html.
