New KCMU report finds most states will aim to cover dual eligibles in demonstration projects
Posted on October 30, 2012 | No Comments
The Centers for Medicare and Medicaid Services (CMS) has proposed two models to align financing for beneficiaries eligible for both Medicare and Medicaid benefits, or dual eligibles. One is a capitated model and one a managed fee-for-service model. In the spring of 2012, 26 states submitted proposals to CMS seeking to test one or both of these models. CMS is presently reviewing the states’ proposals to determine which will be implemented.
According to a report released by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU), 21 of the 26 states that have submitted demonstration project proposals include a plan to insure all dual eligibles in their proposal. CMS has said that it will include as many as 2 million (out of the 9.1 million people eligible for both Medicare and Medicaid nationally) dual eligible beneficiairies in the demonstration project. The remaining 5 states have issued restrictions based on age, diagnosis, and/or service in their proposals. 23 of the 26 states plan to use a passive enrollment system to cover dual eligibles. In other words, the duals would be covered unless they actively chose to opt out of the program.