Magazine article Policy & Practice

MINNESOTA'S: Long-Term Care Program for Dual Eligible Seniors

Magazine article Policy & Practice

MINNESOTA'S: Long-Term Care Program for Dual Eligible Seniors

Article excerpt

In 1995, Minnesota sponsored a Medicare demonstration for dually eligible seniors, which facilitated integration of Medicare and Medicaid service delivery across primary, acute and long-term care. This Minnesota Senior Health Options program merges financing systems using coordinated state and Centers for Medicare and Medicaid Services managed care contracts with health plans, and features integrated enrollment, member materials, care coordination and administrative requirements. Participating health plans are approved as Medicare Advantage Special Needs Plans serving dual eligibles and are required to provide Medicare Part D prescription drug services. Dually eligible members receive drugs, as well as primary, acute and long-term care services, under Medicare and Medicaid through their choice of health plan. Enrollment is voluntary.

MSHO enrollment serves as an alternative to enrollment into a separate mandatory Medicaid-managed care program authorized under a 1915(b) waiver. About 70 percent of Minnesota's Medicaid seniors participate in MSHO, which is now statewide and serves about 36,000 people. Health plans receive separate Medicare payments from CMS and Medicaid payments from the state. Payments and coverage determinations are integrated at the plan level.

No special Medicaid waivers are required. The state uses existing Medicaid state-plan managed care authority for voluntary enrollment along with amendments to existing 1915 waivers for home- and community-based services. The Medicare demonstration ends in December 2007 because all participating health plans are now approved as Medicare Advantage SNPs.

The state contracts with nine SNPs to provide MSHO. All are nonprofit local HMOs that also participate in the state's other Medicaid managed care programs. Satisfaction has been high, disenrollments low and costs controlled. A similar program for people with disabilities, ages 18-64, Minnesota Disability Health Options, began in 2001. Minnesota is expanding integrated Medicare and Medicaid SNP options for people with disabilities.

A number of other states, including Wisconsin, Massachusetts, Texas, New York and Washington, are operating similar programs. The Center for Health Care Strategies is helping several states develop integrated programs. CMS is encouraging dual eligible SNPs to work with states.

State contracting with Medicare managed-care plans for dual eligibles has been under discussion for at least 15 years. Why are states still pursuing these programs and what is the future of state contracting with SNPs for dual eligibles?

Platform for Management of Chronic Conditions

Medicare and Medicaid services need to be managed together to provide a platform for efficient care for the dual eligibles with chronic conditions. The new SNP option under Medicare Advantage provides an opportunity to bring "siloed" Medicare and Medicaid service delivery systems and financing incentives closer. SNPs can be approved to focus enrollment only on dual eligibles, institutional residents or those with chronic and disabling conditions.

Dual eligibles typically have multiple chronic conditions and are the most costly population for both Medicare and Medicaid, with combined cost of more than $200 billion in 2005. States face huge challenges managing costs for soon retiring baby boomers, yet lack tools to influence the costs for the growing population of dual eligibles. With the new dual eligible SNP option, states can contract with selected Medicare SNPs interested in serving dual eligibles to provide Medicaid services, along with Medicare primary and acute care and drugs, creating a platform for chronic care management across both programs. States may also benefit from additional benefits that SNPs are required to provide to duals when there are savings resulting from the Medicare Advantage bid process.

Coordinated Medicare and Medicaid Drug Coverage

Drugs are important for the chronic care conditions experienced by dual eligibles. …

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