Dual-eligible ACO model could be jeopardized by changes to Medicaid

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The Centers for Medicare & Medicaid Services' recently announced accountable care organization model for dual eligibles could be at risk if lawmakers overhaul the Medicaid program in the coming years.

The Medicare-Medicaid Accountable Care Organization is aimed at improving care and lowering costs for beneficiaries enrolled in both Medicare and Medicaid. While one expert told McKnight's last week that the model is unlikely to disappear under the next presidential administration, changes to the Medicaid program may complicate it, according to published reports.

Mark Reagan, an attorney with Hooper, Lundy & Bookman PC, told Bloomberg BNA on Monday that states may be at risk should they begin preparations for the pilot “and the entire form of Medicaid financing changes under the incoming administration.”

CMS is planning to partner with up to six states for the pilot of the model, with priority given to those states with a low Medicare ACO saturation. But with the Trump administration stating it wants to “drastically alter” Medicaid, states may be wary to sign onto the program.

The program could also find itself in limbo should its governing organization, the Center for Medicare & Medicaid Innovation, be eliminated as part of Trump's previously mentioned plans to repeal — or at least get rid of some aspects of — the Affordable Care Act, Reagan noted.