Innovative Approaches to Stratification and Rate Setting
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 brief from the Center for Health Care Strategies describes how three states – California, Ohio, and Virginia – are accomplishing this work.Date Updated: 11/03/2014
Individuals eligible for both Medicare and Medicaid are among the highest-need populations in either program. States integrating care for this population must ensure that individuals’ health and social service support needs are addressed promptly. Stratifying Medicare-Medicaid enrollees by their level of need may help states and health plans in better prioritizing and promptly addressing care management to ensure high-quality, timely care. This brief describes how three states – California, Ohio, and Virginia – are requiring integrated health plans to stratify Medicare-Medicaid enrollees by their level of need within new capitated financial alignment demonstrations.
This is the third report coming from the California Medicaid Research Institute (CAMRI) project entitled: Comprehensive Analysis of Home- and Community-Based Services in California. The report describes Medicare and Medi-Cal spending for those beneficiaries using long-term services and supports funded by Medi-Cal.
The California Medicaid Research Institute (CAMRI) developed an integrated and longitudinal database containing Medi-Cal and Medicare claims and assessment data of LTSS recipients in California in 2008. CAMRI’s integrated database provides a unique opportunity to look at characteristics and program spending across the entire care continuum for beneficiaries with LTSS needs within Medi-Cal and for dual eligibles across Medicare and Medi-Cal. This report focuses on LTSS use and spending in the eight duals demonstration counties.
On March 27, 2013, the State of California and the Centers for Medicare and Medicaid Services (CMS) formalized a Memorandum of Understanding (MOU) to establish a Federal-State partnership to implement the Dual Eligibles Integration Demonstration, also referred to as Cal MediConnect. This Fact Sheet provides background information about Cal MediConnect and summarizes the key points of the MOU.