National Council on Medicaid Home Care Creates Primer to the Ten Dual Eligible Agreements
January 4, 2014 09:04 AM
On November 25, the Centers for Medicare and Medicaid Services (CMS) and the state of Washington signed a Memorandum of Understanding (MOU) establishing the Medicare-Medicaid Alignment Initiative (MMAI) in capitated form for two counties in Washington State. This marked the latest of such MOUs signed coordinating care and financials of the dual eligible population.
Ten (10) MOUs have been signed already in the states of Massachusetts, Washington State (twice), Ohio, Illinois, California, Virginia, New York, Minnesota, and South Carolina. Eight of these MOUs - Massachusetts, Washington State, Ohio, Illinois, California, Virginia, New York, and South Carolina - were signed as part of the MMAI. The MMAI is a joint federal and state project that seeks to improve care and reduce costs associated with beneficiaries eligible for both Medicare and Medicaid, or “dual eligibles.”
These eight states have adopted a capitated model, where CMS, the states, and health plans enter into three-way contracts in which each plan receives a prospective blended Medicare/Medicaid payment to provide coordinated and comprehensive care. A capitated model is a payment model where the payer, in this case the state and CMS, jointly, pays providers a lump sum payment per enrollee for a fixed period of time.
In addition to the above, the State of Washington had previously signed another MMAI MOU with CMS regarding fee-for-service (FFS) health homes in the remaining 37 counties in October 2012. Minnesota has signed a dual eligibles demonstration independent of the MMAI.
The following article compares key aspects of these ten MOUs as they pertain to home care providers. Click here to read full article.