Medicaid Health Plans of America Praises HHS Care Coordination Effort for Medicare-Medicaid Dual Eligibles

Initiative Builds on Integrated Care Model of Medicaid Health Plans

WASHINGTON, May 13, 2011 /PRNewswire-USNewswire/ -- Medicaid Health Plans of America (MHPA) commends Health and Human Services (HHS) Secretary Kathleen Sebelius, Centers for Medicare and Medicaid (CMS) Administrator Donald Berwick, and Melanie Bella, Director of the new Medicare-Medicaid Coordination Office for their recent announcement of two new initiatives to coordinate the care of those dually eligible for both Medicare and Medicaid.  For over two decades, states have looked to Medicaid health plans to provide coordinated care to millions of Medicaid beneficiaries while also achieving improved quality outcomes and predictable costs. Today, however, many of the nation's 9 million beneficiaries eligible for both Medicaid and Medicare – the dual eligibles – still receive fragmented care. These enrollees also pose cost, quality and access challenges to policymakers. Medicaid health plans are well-equipped to provide the coordinated care that dual eligibles need in order to improve health outcomes and achieve cost savings.

"The integrated care coordination that's characteristic of the way Medicaid health plans provide access to quality care for their enrollees is an excellent example to follow for treating the low-income, elderly and disabled patients that make up the dually eligible," said Thomas L. Johnson, MHPA's President and CEO.  "These patients are typically sicker than the average beneficiary, with most of them suffering from several chronic conditions at the same time. Because of this, this segment which comprises a small part of the Medicaid population contributes disproportionately to the cost of the program."

According to HHS, the plan to address the duals is two-fold: the Alignment Initiative, which aims to better integrate the benefits of Medicaid and Medicare, and the facilitation of more timely state access to Medicare data. The disparate benefits of the two programs – Medicare covers acute health care services and prescription drugs and Medicaid covers long-term care services and supports, as well as Medicare premiums and copays – need to be managed in order to make care more cost-effective. Similarly, the sharing of Medicare data will allow Medicaid providers to create full profiles of enrollees to better customize treatment regimens and eliminate wasteful (or even dangerous) redundant interventions. These tactics will enable states to provide seamless care that should improve quality and decrease costs, for example by reducing hospitalizations and ER visits.

While Medicaid health plans are uniquely positioned to provide this coordinated care to dual eligibles, there are still barriers that prevent its delivery. Currently, restrictions in federal law generally exempt the dually eligible population from mandatory enrollment in managed care.  MHPA believes Congress should allow mandatory managed care enrollment for the dual eligibles without requiring states to negotiate cumbersome federal waivers.  Alternatively, HHS should clarify federal policy to allow states to automatically enroll duals in managed care plans provided they are given the option to disenroll. In addition, MHPA supports other policy requests being considered that give states additional flexibilities without resorting to the recent controversial proposals on deficit reduction that could limit access and put the health of Medicaid patients at risk. These alternatives include greater use of copayments and premiums, more flexibility in long-term care options and more flexibility in trying new provider payment models while recognizing their use within a managed care framework.

"Given the high resource utilization of the dually eligible, Medicaid health plans' proven and effective care coordination strategies can go a long way in terms of reining in costs and, more important, improving outcomes for this special needs population," Johnson noted. "MHPA stands ready to assist with the implementation of these important initiatives to ensure that the disadvantaged, aged and disabled get the care they need."

About Medicaid Health Plans of America

Medicaid Health Plans of America (MHPA) is the leading trade association solely focused on representing Medicaid health plans. MHPA provides advocacy, research and organized forums that support the development of policy solutions to enhance the delivery of quality health care. For more information, visit Medicaid Health Plans of America at http://www.mhpa.org or email at [email protected].

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SOURCE Medicaid Health Plans of America