New funding from the CMS and the Administration for Community Living (ACL) will improve coordination of care for Medicare-Medicaid enrollees. This funding will support states in developing independent ombudsman programs, helping dually eligible beneficiaries in the demonstration have a positive care experience.
The demonstration ombudsman programs, based upon the popular consumer resource, are designed to amplify the beneficiary voice in the Financial Alignment initiative. These programs will provide beneficiaries with access to new resources and personal assistance in answering questions and resolving issues related to the demonstration.
They will also carefully monitor the beneficiary experience, and offer recommendations to CMS, the states, and participating plans on how the initiative could be improved.
Through the Financial Alignment initiative, CMS is working with six states to test two models — capitated and managed fee-for-service — to improve the coordination of care for Medicare-Medicaid enrollees. Five of those states are pursuing a capitated model, under which participating states contract with Medicare-Medicaid plans to be accountable for and coordinate delivery of covered services for Medicare-Medicaid enrollees. They are: Massachusetts, Ohio, Illinois, California, and Virginia.
The sixth state, Washington, is pursuing a managed fee-for-service model, by which it would be eligible to benefit from savings resulting from initiatives designed to improve quality and reduce costs for both Medicare and Medicaid.
Source: Center for Medicare and Medicaid Services (CMS) , June 27, 2013
Dual Eligibles: The New Growth Opportunities Ahead for Health Plans examines the initiatives being developed by CMS’ Federal Coordinated Health Care Office to fund large-scale state care-integration demonstrations for dual eligibles, as well as states’ efforts to more effectively coordinate care for these patients.