Report: States propose managed care plans for dual eligibles

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All of the 15 states selected by the Centers for Medicare & Medicaid Services to develop better plans for dual eligibles have proposed managed care models.
A recent Kaiser Family Foundation report summarizes proposals of 15 states that were awarded contracts of $1 million by the Center for Medicare & Medicaid Innovation to develop coordination plans for the vulnerable dual eligible population. There are nine million dual eligibles in the United States, and they qualify separately for both Medicare and Medicaid. Dual eligibles are more likely than other Medicare recipients to be in nursing homes, according to the report.

The managed care plans included in the proposals are both risk-based and non-risk based. For example “behavioral health and long-term care services, including institutional care, frequently are provided outside of Medicaid managed care plans on a fee-for-service basis,” the report says. “Medicaid provides home and community-based long-term care services to dual eligibles primarily through waivers, most of which are financed on a fee-for-service basis, with some states moving toward managed care provision of long-term care services.”

States who submitted proposals were: California, Colorado, Connecticut, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington and Wisconsin.