Va.'s Medicaid/Medicare enrollees to be dually enrolled

Feds approve coordinated care

5/21/2013, 3:22 p.m.

— Virginia has been approved to implement a new health care initiative, the Medicare-Medicaid Enrollee (dual eligible) Financial Alignment Demonstration, meant to coordinate care for more than 78,000 Virginians currently enrolled in Medicare and Medicaid.

The new initiative, recently branded as Commonwealth Coordinated Care, will coordinate care for those who meet certain eligibility requirements and are served currently by both Medicare and Medicaid. Commonwealth Coordinated Care is designed to be the single program accountable for coordinating the delivery of primary, preventive, acute, behavioral, and long-term services and supports for this population.

The initiative is meant to provide Virginians with high quality health care as well as support coordinating the Medicare and Medicaid benefits into a single person-centered program.

For years, Virginia has struggled with how best to manage and finance the care of those receiving both Medicare and Medicaid.

"Securing the federal agreement to launch Commonwealth Coordinated Care is a significant victory for these beneficiaries and the commonwealth," the Virginia governor's office said in a press release. "It aids the department’s ability to better structure and coordinate services tailored to the health, behavioral health, and long-term service needs of Virginia’s most vulnerable adults."

The Department of Medical Assistance Services budget forecast for state fiscal year 2014 included $11.3 million in general fund savings based on the new program. These savings assumed a Jan. 1, 2014 implementation date as well as a 50 percent match rate. Due to timing of the DMAS forecasting process, the savings were estimated before the agreement with CMS was reached which laid out the rate setting methodology and cost savings sharing agreed upon for the program. These factors may alter the initial forecast which will be updated in the next budget cycle.

Medicare and Medicaid were originally not designed to work together, yet there are more than 78,000 Virginians who currently participate in both programs and will now be eligible for Commonwealth Coordinated Care.

Under the existing structure, Medicare-Medicaid enrollees must use three separate ID cards for Medicare, Medicaid and prescription drugs, have three different sets of benefits, receive bills when they should not, and are routinely frustrated over challenges in understanding which plan pays for which services. By choosing this voluntary program, individuals will have one ID card for all aspects of their care, a 24 hour/seven day a week toll-free number for assistance, person-centered service coordination and case management, and one appeals process.

Under Commonwealth Coordinated Care, Virginia and the federal Centers for Medicare and Medicaid Services (CMS) will enter into a contract with health plans for the delivery of coordinated services and supports to enrollees. Eligible individuals include older adults and individuals with disabilities, including those receiving long-term services and supports, and who live in designated regions around the Commonwealth. The regions include the areas surrounding: Central Virginia/Richmond, Charlottesville, Tidewater, Roanoke and Northern Virginia.

Commonwealth Coordinated Care begins in January 2014, and will continue through Dec. 31, 2017. Congressional action will be needed in order for the program to continue beyond 2017. A rigorous evaluation will be conducted throughout the demonstration period.