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Michigan Allowed to Move Dual Eligibles to Managed Care

managed careApproximately 9 million people in the United States are covered by both Medicare and Medicaid, including seniors with low income and younger people with disabilities. These so-called "dual eligibles" often have complex and costly health needs, and lawmakers have been seeking ways to reduce costs while maintaining and improving care for this segment of the population. Traditionally, coverage and care for dual eligibles has tended to be fragmented and expensive given the challenges posed by separate entities (Medicare and Medicaid) with separate coverage policies.

A number of states, including Michigan, have been working with the Centers for Medicare and Medicaid Services (CMS) to develop proposals to address these challenges, based on new authority in the Affordable Care Act. Through this initiative, 15 states were granted federal funding to help them better coordinate care for dual eligibles. Each of the states, including Michigan, was awarded up to $1 million to help develop new strategies and programs addressing these challenges.

CMS has recently approved a Michigan demonstration program that will move dual eligibles into managed care. The Michigan Department of Community Health described the demonstration as follows:

"In the demonstration, services and supports for persons who are dually eligible will be delivered by newly created Integrated Care Organizations (ICOs) and currently existing Prepaid Inpatient Health Plans (PIHPs). ICOs will be responsible for the provision of all physical health, long term care, and pharmacy services, while PIHPs will be expected to cover behavioral health and habilitative services for people with developmental disabilities, mental illness, or substance use issues. The ICOs and PIHPs will be connected through the Care Bridge, a care model that requires the coordination of services and supports between the two entities and involved providers."

Michigan is the 11th state to receive such permission. The hope is that by integrating dual eligibles into a managed care structure, care in Michigan will be better coordinated and the expenses involved in administering dual eligible coverage will decline.

We will continue to keep you informed about Michigan’s progress in implementing this reform.

Categories: Health Care Reform, Insurance, Medicare/Medicaid, Providers


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