Stratifying Medicare-Medicaid enrollees by their level of need may help states and health plans prioritize and promptly address the care management needs of these individuals in order to ensure high-quality, timely care. This new brief from the Center for Health Care Strategies describes how three states - California, Ohio, and Virginia - are accomplishing this work.
The duals coordinated care demonstration projects require a three-way contract between participating states, health plans, and the Center for Medicare and Medicaid Services (CMS). Massachusetts was the first state to sign a three-way contract. The National Senior Citizen’s Law Center report, "Massachusetts Three-Way Contract: A Summary of Beneficiary Protections," provides insight into the rights
As more states transition Medicaid long-term services and supports (LTSS) to a managed care model, growing attention is being placed on consumer protections. AARP published a report, "Consumer Choices and Continuity of Care in Managed Long-Term Services and Supports: Emerging Practices and Lessons," identifying strong consumer education strategies as paramount to increased consumer involvement and meaningful choice. While consumers did not experience significant interruptions in services during the transition period to managed LTSS, continued monitoring will be required for long-range impact on choice and continuity of care as plans gain more flexibility in managing their networks.
The MedPAC Data Bookprovides information on national health care and Medicare using tables and figures with brief discussions. Information covered includes Medicare spending, Medicare beneficiary demographics, dual-eligible beneficiaries, quality of care in the Medicare program, and examination of provider settings.
States looking to better coordinate care and manage cost are seriously considering the managed care model as an option to provide Medicaid services to people with complex health care needs. The Kaiser Commission on Medicaid and the Uninsured issue brief, "Transitioning Beneficiaries with Complex Care Needs to Medicaid Managed Care: Insights from California," examines how providers, health plans, and community-based organizations in three counties (Contra Costa, Kern, and Los Angeles) experienced the California’s transition of approximately 240,000 seniors and people with disabilities to Medicaid managed care. This brief reinforces the need for adequate time, communication, planning, and partnerships in order to ensure continuity of care.