Good News [for a change] for Challenged Duals Demonstration


Medicare’s struggling demonstration project that melds Medicare and Medicaid services and payments for individuals eligible for both programs got a boost last week.

Some positive statistics on Minnesota’s blended demo were highlighted in research by the Urban Institute and consultant RTI International for the U.S. Health and Human Services Department.

The dual eligibles in the Minnesota demonstration were found to be 48 percent less likely to have a hospital stay and 6 percent less likely to have an outpatient emergency department visit than a similar population just enrolled in Medicaid managed care. Enrollees in the demo were almost three times more likely to have a primary care visit and 16 percent less likely to have any assisted living services.

And, once enrolled, nearly all beneficiaries wanted to stay put, rather than switch to a Medicaid-only managed care plan, according to the report.

Minnesota is one of 13 states participating in the federal Medicare agency’s Financial Alignment Initiative. The concept is that better merging of Medicare and Medicaid services can help improve health outcomes for people enrolled in both programs.

The initiative has struggled amidst refusals to participate by beneficiaries and providers in some states. There are tales of nursing homes in Virginia, for example, stuffing residents’ opt-outs in envelopes and sending them to the agency. The state recently rejected the federal agency’s invitation to extend the program after initial three years expires.

Overall, just 30 percent of eligible beneficiaries are enrolled in the initiative, according to the Medicare Payment Advisiory Commission.

But Minnesota’s Senior Health Options seems to be working. It doesn’t hurt that the state had a head start over the other dozen initiative participants. Minnesota started the program as a pilot on its own almost 20 years ago and linked it to the federal initiative in 2013. 

The question now is, Andrea Marsca of the National Association of Medicaid Directors told me: “How do we--states, federal policymakers, providers and advocates--adapt the model to fit the unique health care landscape in the states?”

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