Americans who qualify for both Medicare and Medicaid represent the highest-need, highest-cost groups of patients in the nation’s health care system. Due to the misalignment of policies, payments, and incentives across the two programs, the care that dual eligible patients receive is often fragmented, marked by disruptions in services and a general lack of continuity. Through the Affordable Care Act, the newly established Medicare-Medicaid Coordination Office and Center for Medicare and Medicaid Innovation is providing demonstration funding to 15 states to implement integrated care programs focused on higher quality and more cost-effective care for dual eligibles.

CHCS, with support from The SCAN Foundation and The Commonwealth Fund, provided targeted technical assistance (TA) to help select demonstration states in developing and implementing innovative payment and delivery models for duals. The participating states were California, Colorado, Connecticut, Massachusetts, Michigan, Minnesota, Oklahoma, Oregon, Tennessee, Vermont, Washington, and Wisconsin.

The initiative provided a platform for sharing information and resources among participating states and federal officials with a focus on helping states to:

  • Obtain and utilize Medicare data and create analytical models to demonstrate the cost-effectiveness of proposed state programs;
  • Establish clear messages to facilitate stakeholder communication and involve all stakeholders — providers, state officials, beneficiaries, etc. — in planning processes, design, and implementation;
  • Develop reimbursement strategies linked to clearly defined performance metrics and evaluation processes; and
  • Finalize their demonstration model, including comprehensive communication plans and evaluation protocols.

This TA initiative built on CHCS’ previous state collaboratives, Transforming Care for Dual Eligibles and the Integrated Care Program, that facilitated linkages between 12 states and CMS to foster new models of integration for duals.