News for individuals eligible for Medicaid and Medicare in Washington

The Centers for Medicare and Medicaid Services (CMS) negotiated a memorandum of understanding (MOU) with the state of Washington to test a managed fee-for-service model for integrating health care for Medicare-Medicaid enrollees. Washington’s plan is called HealthPath Washington. The state will build on the Health Home model.

Massachusetts takes step to integrate and coordinate care for individuals who are dual eligibles

Massachusetts is the first state to negotiate a memorandum of understanding (MOU) with the Centers for Medicare and Medicaid Services (CMS) addressing its proposal to integrate and coordinate care for individuals who are dually eligible for Medicare and Medicaid. The National Senior Citizens Law Center (NSCLC) has prepared a summary of the MOU. Massachusetts plans to begin implementation of its plan in April 2013. Individuals aged 18-64 will be included in the plan, including individuals with intellectual and developmental disabilities who do NOT receive home and community based waiver services or services in an intermediate care facility for individual with intellectual/developmental disabilities (ICF/ID).

Medicare Payment Advisory Commission discusses Duals

The Medicare Payment Advisory Commission (MedPAC) devoted an hour and one-half to discussion about the proposals to integrate and coordinate care for individuals who are dually eligible for Medicaid and Medicare (Duals) that states are designing. Commission members expressed concern about automatic enrollment of Duals in managed care plans. The Commission Chair, Glenn Hackbarth, said that matching health plans with beneficiaries who have complex health needs will be critically important. The Centers for Medicare and Medicaid Services (CMS) has estimated that the demonstrations will enroll up to two million (20%) of the nation’s Duals. Another commissioner wondered where Duals who choose to opt out of managed care plans would go – would there be something to opt into. Commissioners also discussed the size of the demonstrations and wondered where comparison groups would be if a state plans to enroll all of its Duals in the demonstration. One commissioner thought that the proposals were more like Medicaid waivers than Medicare demonstrations. Although commissioners expressed unease about the demonstrations, they concluded the discussion by emphasizing the need to change the status quo which does not necessarily ensure quality care and is very costly.

Integrated coordinated healthcare plans for Duals

Executives of State Chapters of The Arc in states that are designing integrated healthcare plans for people eligible for both Medicare and Medicaid (Duals) met with officials from the Centers for Medicare and Medicaid Services (CMS), the Administration on Developmental Disabilities (ADD), and The Office on Disability. CMS is working with several states as they redesign their systems of healthcare for Duals in an effort to improve care and reduce costs. Approximately, one-third of Duals are individuals with disabilities. The state chapter executives shared their vast experience in designing services and supports for individuals with I/DD with federal officials. Numerous suggestions were offered concerning essential, non-negotiable elements that must be made part of any healthcare design that integrates medical care and long term services and supports for individuals with I/DD.

Health care costs for dual eligibles

The Centers for Medicare and Medicaid Services (CMS) released an Informational Bulletin concerning billing individuals who are eligible for both Medicare and Medicaid (dual eligibles) for health care costs not covered by either program.  The Qualified Medicare Beneficiary (QMB) is a Medicaid program that pays for Medicare premiums, deductibles and co-payments for individuals with low incomes.  Providers of Medicare services are prohibited from billing QMBs for deductibles, coinsurance, or copayments.

CMS released an Informational Bulletin concerning Section 3309 of the Affordable Care Act which eliminates Medicare Part D cost-sharing for full benefit dual eligible individuals receiving home and community-based services in lieu of institutional services.  Section 3309 became effective on January 1, 2012.

Affordable Care Act benefits for dual eligibles

The Affordable Care Act provides that full-benefit dual eligibles (those who qualify for both Medicare and full Medicaid benefits) who are receiving Medicaid home and community based services (HCBS) are eligible for a full waiver of copayment requirements for their Medicare Part D prescription drugs. This policy became effective January 1, 2012.  The provision puts people who are receiving HCBS in the community on equal footing with those who reside in institutions and whose co-pays are also waived. The National Senior Citizens Law Center has prepared a helpful summary for advocates.