State Demos to Integrate Care and Payment of Duals

State Demos to Integrate Care and Payment of Duals

State / Targeted Population / Estimated Savings / Proposed Delivery System / Enrollment and Eligibility Methods / Proposed Payment Method / Data collection and analysis / Approved/State Gets Contract
AZ / Managed care, single contractor provides all benefits / Mandatory with opt out, except MA members and American Indians / Medicare capitates the contractors directly (state not seeking payment) / Needs Medicare encounter data. / No
CA / Full benefit duals in 4 counties (150,000 in two years). / Integrated care pilots, one managed by a county organized health system, one under a -2 plan county model / Blended funding at state or health plan level. / Medicare, Medi-Cal, hosp. discharge, LTC assessment, CA Medicaid Research Institute / YES
CO / YES
CT / All (full and partial)duals 65+, excludes Medicare Advantage enrollees; in year 3 expands to younger pop / CMS retains 30% of savings, 70% flows to state. / Local integrated care orgs. (ICO) w/ health homes / Opt out / Medicare & Medicaid payments initially, w/ plan to phase in alternative. Models, e.g., global or partial capitation, episode-based bundled payments; ICOs pay providers based on performance incentive metrics. / Medicare & Medicaid data, in-house actuarial unit and contract w/Mercer / YES
IA / Severe mental illness first, other pops later / Integrated health home model / Health homes screening tool with entrance criteria being developed / Per member per month (PMPM) care coordination payments and annual P4P payments to health homes / Analysis of linked Medicare & Medicaid data / No
MA / Dual adults aged 21-64 (115,000 people) / 1.5% to 2% savings / MCOs, SNP, direct care provider networks, medical homes, ACOs, hospital networks / Risk adjusted, integrated negotiated Medicare & Medicaid funding, shared savings system. / YES
MI / Traditional managed care, SNPS, and ACOs, medical homes / Mandatory enrollment w/ opt out; single standardized assessment tool / Medicare funds transferred to state via risk-adjusted capitation payment derived from Medicare data / Medicare and Medicaid data, U. of MI, Research Data Assistance Center, Hilltop Institute, Health Mgt Assoc. / YES
MN / YES
NY / Explore managed LTC, gain sharing, PACE w/o walls / YES
NC / Expanded medical home demo and include LTC / YES
OH / Nursing facility and HCBS duals, and severe persistent mental illness first / 50% of savings resulting from reduced PMPM for Medicare individuals to be returned to state / Integrated care delivery system via managed care plans, ACOs, health homes and other integrated models. / One blended Medicare and Medicaid rate; would include incentive payments and shared savings / Decision Support System / No
OK / 1) 2,200 in northeast OK (Tulsa area);
2) general duals, but emphasis on citizens with behavioral health needs; 3) PACE-eligible / 1)Community driven ACO w/med. educ., patient centered med. homes, Beacon comm.;
2) state insurance program;
3) statewide PACE / 1)Capitation, case rates, bundles,
2) Combine Medicare and Medicaid to purchase state insurance;
Capitated PACE payments / Medicare, Sooner Care MMIS / YES
OR / All dual eligibles entitled to full Medicaid benefits / More than $2.5 billion over 5 years / Person-centered health homes, regional ACOs / Capitation payments and/or global budgets, blended Medicare and Medicaid funds / All Medicare Part A and B claims, Medicaid and Medicare Advantage / YES
RI / NO
SC / YES
TN / YES
VT / All duals / Medicare money to state for managing all dual benefit plans / YES
WA / YES
WI / YES