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Webinar Replay: Continuing the Path to Medicare-Medicaid Integration

This webinar was held on October 4, 2021.

Federal and state policy makers have long been working to expand enrollment in Medicare-Medicaid integrated care programs (ICPs). ICPs can advance independent living and health equity for individuals who are dually eligible for both programs. However, approximately only one in 10 dually eligible individuals was enrolled in an ICP as of 2019. To encourage ICP enrollment and retention, 红领巾瓜报 identified 10 essential elements of ICPs centered around, informed by, and made available to dually eligible individuals. (See 红领巾瓜报 Brief #3 and the brief fact sheet.)

During this webinar, 红领巾瓜报 shared these 10 essential elements for establishing and simplifying ICPs specifically tailored to diverse individuals鈥� needs and preferences. Panelists involved in health justice and community-based healthcare offered practical next steps for advancing ICPs.

Learning Objectives

Hear about the 10 essential elements for ICPs identified through interviews with diverse stakeholders
Engage panelists to share their views on how to advance ICPs tailored around members鈥� needs
Consider the types and level of investment required to advance the essential elements for ICPs

Speakers

Arielle Mir, MPA, Vice President of Health Care, Arnold Ventures, Washington, DC
Sarah Barth, JD, Principal, 红领巾瓜报, New York, NY
Ellen Breslin, MPP, Principal, 红领巾瓜报, Boston, MA
, Health Justice Policy Analyst, Disability Policy Consortium, Malden, MA
Linda Little, MBA, RN, CCM, President and CEO, Neighborhood Service Organization (NSO), Detroit, MI

红领巾瓜报 briefs on Medicare-Medicaid integration

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This issue brief听from 红领巾瓜报,听Medicare-Medicaid Integration: Essential Program Elements and Policy Recommendations for Integrated Care Programs for Dually Eligible Individuals听is part of a multi-phased research initiative to increase enrollment in integrated care programs (ICPs)^[1]^听that meet full benefit dually eligible individuals鈥�^[2]听needs and preferences. Dually eligible individuals have a range of chronic conditions and disabilities requiring both Medicare and Medicaid services, which makes integrated programs important to their lives.

For a succinct overview of the essential elements and policy recommendations, please access the听brief fact sheet. For a full discussion of the elements and policy recommendations, please access the听full brief.

The authors are Sarah Barth, Ellen Breslin, Samantha DiPaola and Narda Ipakchi.^[3]

For further information or questions, contact Sarah Barth, Ellen Breslin or Samantha DiPaola.

[1]听Integrated Care Programs (ICPs): For this research, we defined ICPs as financing and care delivery organizing entities or programs that coordinate and integrate Medicare and Medicaid-covered services and supports for dually eligible individuals.They include the Centers for Medicare & Medicaid Services (CMS) Financial Alignment Initiative (FAI) capitated and fee-for-service models; the Program of All-Inclusive Care for the Elderly (PACE); Medicare Advantage (MA) Fully Integrated Dual Eligible Special Needs Plans (FIDE SNPs); Medicaid Managed Long-Term Service and Supports Program (MLTSS) managed care organizations and aligned MA dual eligible special needs plans (D-SNPs); and state-specific programs that may be proposed to CMS.

[2]听Dually Eligible Individuals:听When using the term dually eligible individuals, we are referencing Medicare-Medicaid full benefit dually eligible individuals (FBDEs), those who qualify for full Medicaid benefits.

[3]听Narda Ipakchi was formerly a Senior Consultant with 红领巾瓜报.

Medicare-Medicaid integration: key elements and policy recommendations for dual eligible care programs

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This week, our In Focus section releases a new brief from 红领巾瓜报, Medicare-Medicaid Integration: Essential Program Elements and Policy Recommendations for Integrated Care Programs for Dually Eligible Individuals. The authors are Sarah Barth, Ellen Breslin, Samantha DiPaola and Narda Ipakchi.^[1]

State efforts to integrate care across Medicaid FFS LTSS and Medicare Advantage D-SNPs

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This week, our In Focus section reviews a new paper from 红领巾瓜报,State Efforts to Integrate Care Across Medicaid Fee-for-Service Long-Term Services and Supports and Medicare Advantage Dual Eligible Special Needs Plans by Sarah Barth, Rachel Deadmon and Julie Faulhaber. Funded by UnitedHealthcare, this paper outlines approaches taken by Medicaid programs seeking to coordinate Medicare and Medicaid services for dually eligible individuals without first implementing standalone Medicaid managed long-term services and supports (MLTSS) programs.

红领巾瓜报 brief examines state efforts to integrate care across Medicaid FFS LTSS and Medicare Advantage D-SNPs

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Funded by UnitedHealthcare, the issue brief, State Efforts to Integrate Care Across Medicaid Fee-for-Service Long-Term Services and Supports and Medicare Advantage Dual Eligible Special Needs Plans, outlines approaches taken by Medicaid programs seeking to coordinate Medicare and Medicaid services for dually eligible individuals without first implementing standalone Medicaid managed long-term services and supports (MLTSS) programs.

Authors are Sarah Barth, Rachel Deadmon and Julie Faulhaber.

红领巾瓜报 examines CMS Innovation Models over the past decade

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A new issue brief and accompanying data set by 红领巾瓜报 colleagues examines models implemented by the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (The Innovation Center) over the past decade and provides evaluation of the findings.

Which Medicare changes should continue beyond the COVID-19 pandemic? Four questions for policymakers

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In an prepared for The Commonwealth Fund and The SCAN Foundation, 红领巾瓜报 consultant Jennifer Podulka and Vice President Jonathan Blum, analyze the temporary COVID-19-related changes to Medicare regulations, described the benefits and risks of the changes, and offered a framework to support policymakers鈥� decisions on the future of these temporary policies.

红领巾瓜报 authors report examining future of COVID-19 Medicare regulation changes

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A new Issue Brief, authored by Jennifer Podulka and Jon Blum, examines the many changes to Medicare regulations put in place during the COVID-19 pandemic. The brief, Which Medicare Changes Should Continue Beyond the COVID-19 Pandemic? Four Questions for Policymakers, tracks and categorizes the regulatory changes, describes the benefits and risks of the changes, and establishes a framework to support policymakers鈥� decisions regarding the future for the changes after the pandemic ends.

CMS proposed rule to repeal market-based MS-DRG weight methodology for inpatient hospitals

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This week, our In Focus section reviews the key provisions of the Centers for Medicare & Medicaid (CMS) Fiscal Year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Acute Care Hospital (LTCH) Proposed Rule (), which includes Medicare payment updates and policy changes for the upcoming FY, with a comment deadline of June 28, 2021. This year鈥檚 proposed rule includes several proposals the hospital industry should carefully consider. In particular, the Biden Administration has proposed to:

红领巾瓜报 analysis finds provider-sponsored MA plans generally have lower churn rates

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This week, our听In Focus听section examines differences in Medicare Advantage (MA) churn rates among select provider-sponsored plans (PSPs) and non-PSPs. Enrollee churn rates, or rates at which enrollees switch plans, may be an indicator of enrollee satisfaction.听In the years studied, PSP organizations had lower average churn rates compared to non-PSP organizations. 听

Dual eligible financial alignment demonstration 2021 enrollment update

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This week, our In Focus section reviews publicly available data on enrollment in capitated financial and administrative alignment demonstrations (鈥淒uals Demonstrations鈥�) for individuals dually eligible for Medicare and Medicaid (dual eligibles) in nine states: California, Illinois, Massachusetts, Michigan, New York, Ohio, Rhode Island, South Carolina, and Texas. Each of these states has begun either voluntary or passive enrollment of dual eligibles into fully integrated plans providing both Medicaid and Medicare benefits (鈥淢edicare-Medicaid Plans,鈥� or 鈥淢MPs鈥�) under three-way contracts between the state, the Centers for Medicare & Medicaid Services (CMS), and the MMP. As of February 2021, approximately 392,000 dual eligibles were enrolled in an MMP. Enrollment rose 5.7 percent from February of the previous year.

红领巾瓜报 analysis of Medicare Advantage Star rating challenges

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This week, our In Focus section highlights changes that may affect the Centers for Medicare & Medicaid Services (CMS) Medicare Advantage Star Rating program and how these changes impact future summary Part C & D Star Rating scores. As the CMS Medicare Advantage Star Rating program continues evolving from year to year, many plans have yet to achieve at least four star status, and therefore are missing out on additional Medicare revenues. The Star Rating landscape is expected to change drastically over the next two years for plans due to CMS鈥� continued focus on phasing-in greater reliance on outcomes measures and measures of care experience, rather than process measures. As a result, many plans are at risk of losing their four star overall rating and underperforming plans could be at risk of receiving a low performance indicator.

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Webinar Replay: Continuing the Path to Medicare-Medicaid Integration

红领巾瓜报 briefs on Medicare-Medicaid integration

Medicare-Medicaid integration: key elements and policy recommendations for dual eligible care programs

State efforts to integrate care across Medicaid FFS LTSS and Medicare Advantage D-SNPs

红领巾瓜报 brief examines state efforts to integrate care across Medicaid FFS LTSS and Medicare Advantage D-SNPs

红领巾瓜报 examines CMS Innovation Models over the past decade

Which Medicare changes should continue beyond the COVID-19 pandemic? Four questions for policymakers

红领巾瓜报 authors report examining future of COVID-19 Medicare regulation changes

CMS proposed rule to repeal market-based MS-DRG weight methodology for inpatient hospitals

红领巾瓜报 analysis finds provider-sponsored MA plans generally have lower churn rates

Dual eligible financial alignment demonstration 2021 enrollment update

红领巾瓜报 analysis of Medicare Advantage Star rating challenges

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Featured 红领巾瓜报 insights:

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