Medicare and Medicaid Integration: Results of California’s Dual Financial Alignment Demonstration
Year: 2017
Type: conference-abstract
Abstract: Over 9.6 million seniors and adults with disabilities in the United States (US) are dually eligible for Medicaid and Medicare. These beneficiaries (called “duals”) have, on average the most complex care needs and account for a disproportionate share of spending in both programs. The Patient Protection and Affordable Care Act gave the Centers for Medicare and Medicaid Services (CMS) the authority to develop and test new models for integrating care for duals. California’s dual alignment demonstration (the largest of the 12 state demonstrations) passively enrolled over 120,000 [ML1] dually eligible beneficiaries into Cal MediConnect (CMC) health plans, where Medicare and Medicaid services (including long-term services and supports -LTSS) were coordinated through a capitated managed care model. Enrollees received additional care coordination, transportation services, and expanded vision and dental benefits. Beneficiaries could opt out of the program and keep fee for service Medicare. Using a participatory evaluation approach, researchers worked with diverse stakeholders including the state Medicaid agency, CMC health plans, disability advocates, provider groups and consumers to design an evaluation of the program. The evaluation sought to document health plan innovation and health system response to the demonstration, as well as beneficiaries’ experiences with care. In this symposium, researchers will present results outlining the unique innovations and collaborations that resulted from the implementation of the program. Additionally, results of a representative telephone survey of 2,139 beneficiaries examining the demonstration’s impact on access to care, continuity of care, and managed LTSS will be presented.
Source: Innovation in Aging
Authors: C.L. Graham, B. Hollister, L. O’Shea
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $3,977
OpenAlex ID: W2731152828