State, CMS pair up on duals

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The Centers for Medicare & Medicaid Services and the state of Illinois are teaming up in a dual eligible payment demonstration.

Under the Medicare-Medicaid Alignment Initiative, the state and CMS are contracting with health plans to coordinate health services. Illinois is the fourth state to enter a Memorandum of Understanding with CMS to participate in the demonstration, and the third to employ the capitated model. 

By January 2014, Illinois beneficiaries who did not select or opt out of the demonstration will be assigned a health plan. Each health plan will “be responsible for developing and operating specialized programs to assist with transition of care and to reduce avoidable hospital and nursing facility admissions,” CMS stated.  

The project will involve more than 135,000 dual eligibles in the Chicago area and central Illinois. 

Medicare and Medicaid spending is estimated to reach $330 billion in 2013, according to a January report from UnitedHealth Center. A large part of that goes to pay for long-term care services, causing Sen. Max Baucus (D-MT) to question whether providers were “gaming” the system last year. Meanwhile, his colleague, Sen. Jay Rockefeller (D-WV), called managed-care programs for dual eligibles a “losing situation.”

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