What Is The Status Of The Dual Eligible Demonstrations?
An OPEN MINDS Market Intelligence Report
The Centers for Medicare & Medicaid Services (CMS) launched state dual eligible demonstrations to integrate care for full-benefit dual eligible individuals in April 2011 to expand access to integrated programs that coordinate Medicaid and Medicare benefits. Dual eligible are consumers who are eligible to receive benefits from both Medicaid and Medicare. All dual eligible qualify for full Medicare benefits, but the amount of Medicaid benefits vary based on the state Medicaid program and the consumer’s eligibility. For all dual eligible, Medicare is the primary payer for acute and post-acute services, and Medicaid is the payer of last resort.
Medicare eligibility is based either on age or a disability determination. Medicaid eligibility is based on either income or a determination that high medical costs make the beneficiary “medically needy.” Dual eligible disproportionately qualify for Medicare and Medicaid on the basis of physical or mental disability – a factor that increases their need for health care, rehabilitation services, and long-term care and that reduces their ability to navigate the health care system.
A total of 26 states originally submitted proposals to participate in the dual eligible demonstrations with CMS. As of January 2016, 13 states have withdrawn their proposals, 12 states have implemented their demonstration, and one state is planning to implement their demonstration in the near future.
The demonstration is testing two models of care – a capitated model and a managed fee-for-service model. In late 2015 and early 2016, the preliminary results of these demonstrations become available. This report explores those evaluations and provides analysis on how the evaluations will effect the continuation of the demonstrations. The report answers a number of questions, including:
- What Are The Dual Eligible Demonstrations?
- What States Have Dual Eligible Demonstrations?
- What Are The Key Features Of Each State’s Dual Eligible Demonstration?
- How Are Dual Demonstration Savings Calculated?
- What Is The Current Enrollment Of The Dual Eligible Demonstrations?
- What Are The Early Results Of The Dual Eligible Demonstrations?
- What Is The Future Of Dual Eligible Demonstrations?