The document summarizes Illinois' Medicare-Medicaid Alignment Initiative to integrate care and financing for dual eligible beneficiaries (9 million Americans enrolled in both Medicare and Medicaid). It aims to improve quality of care while lowering costs by 1-5% annually through care coordination and capitated managed care plans. Key aspects include voluntary enrollment of 135,825 beneficiaries in capitated financial models, unified processes, and testing through the Center for Medicare and Medicaid Innovation's financial alignment demonstrations in six states.
Getting Real About Single Payer:
The Economic Argument for the Long Term
Walter Tsou, MD, MPH
Health Care for All Pennsylvania (www.healthcare4allpa.org)
February 7, 2015
Virginia AFP's lobbyist Hunter Jamerson's presentation from the 2013 SLC on the unique Medicaid reform approach being followed in the state of Virginia.
Establishing a Community-based Framework for ACOs - slide-share 120116Jennifer D.
With the rapid growth of state Medicaid, Medicare, and commercial ACOs, now is the time to establish best practices for addressing the full spectrum of patient needs within an accountable care setting.
The Challenges and Opportunities of Integrated Health HomesMary Tolan
Fragmented care has long been a frustrating thorn in the sides of those living with multiple or chronic illnesses. Despite the complexity of their conditions, these patients often receive little to no support when coordinating their medical treatment and struggle to shoulder the administrative burden themselves.
It is a Citizen Engagement Project of Massive Open Online Course (MOOC) "Engaging Citizens: A Game Changer for Development?". The objetive of Project is to create a sustained national multi stakeholder dialogue in health. That aim to legitimately decide about coverage benefit plan and resource allocation with the objective of improving health outcomes in a new social contract.
Domestic Innovative Financing for Health: Learning From Country ExperienceHFG Project
Advances in health care are extending and improving the quality of life for people around the world, but such advances come with a price tag. While all nations face budgetary constraints for health funding, low- and middle-income countries have the fewest resources for their health sectors. And as many of these nations begin transitioning away from donor-funding for health programs, they need to ensure that any financing gaps are not covered by households paying out-of-pocket in a way that increases inequities in health access and pushes more people into poverty. Clearly, there is a need for low- and middle-income countries to increase the flow of equitable and sustainable domestic financing for health.
A new HFG report —Domestic Innovative Financing for Health: Learning From Country Experience—highlights “domestic innovative financing” options; that is, those originating from domestic sources which can generate additional resources for the health sector. The focus of the report is not to prioritize revenue generation, but rather to “assess country experience with domestic innovative financing options, both successes and failures, in order to increase global wisdom on selecting and implementing them in low- and middle-income countries.” It draws on lessons learned from several countries to provide evidence and scenarios for low- and middle-income nations to increase the financing potential of national health systems.
Medicaid is a government health insurance program that can be used to offer services in supportive housing programs. Under the new Health Care Reform law, virtually all homeless people will be eligible, and can benefit from configuring supportive housing services to take advantage of Medicaid reimbursement. Consideration will be given to the administrative and data burdens inherited when a housing provider becomes eligible for reimbursement from Medicaid/medical assistance, as well as the benefits of delivering a flexible array of supports to maintain persons in their homes.
How do medicaid waivers expand the possibilities of whole person care 032117Jennifer D.
With the changing landscape in healthcare right now it's important to know how Medicaid Waivers and Whole Person Care can help secure positive outcomes.
Getting Real About Single Payer:
The Economic Argument for the Long Term
Walter Tsou, MD, MPH
Health Care for All Pennsylvania (www.healthcare4allpa.org)
February 7, 2015
Virginia AFP's lobbyist Hunter Jamerson's presentation from the 2013 SLC on the unique Medicaid reform approach being followed in the state of Virginia.
Establishing a Community-based Framework for ACOs - slide-share 120116Jennifer D.
With the rapid growth of state Medicaid, Medicare, and commercial ACOs, now is the time to establish best practices for addressing the full spectrum of patient needs within an accountable care setting.
The Challenges and Opportunities of Integrated Health HomesMary Tolan
Fragmented care has long been a frustrating thorn in the sides of those living with multiple or chronic illnesses. Despite the complexity of their conditions, these patients often receive little to no support when coordinating their medical treatment and struggle to shoulder the administrative burden themselves.
It is a Citizen Engagement Project of Massive Open Online Course (MOOC) "Engaging Citizens: A Game Changer for Development?". The objetive of Project is to create a sustained national multi stakeholder dialogue in health. That aim to legitimately decide about coverage benefit plan and resource allocation with the objective of improving health outcomes in a new social contract.
Domestic Innovative Financing for Health: Learning From Country ExperienceHFG Project
Advances in health care are extending and improving the quality of life for people around the world, but such advances come with a price tag. While all nations face budgetary constraints for health funding, low- and middle-income countries have the fewest resources for their health sectors. And as many of these nations begin transitioning away from donor-funding for health programs, they need to ensure that any financing gaps are not covered by households paying out-of-pocket in a way that increases inequities in health access and pushes more people into poverty. Clearly, there is a need for low- and middle-income countries to increase the flow of equitable and sustainable domestic financing for health.
A new HFG report —Domestic Innovative Financing for Health: Learning From Country Experience—highlights “domestic innovative financing” options; that is, those originating from domestic sources which can generate additional resources for the health sector. The focus of the report is not to prioritize revenue generation, but rather to “assess country experience with domestic innovative financing options, both successes and failures, in order to increase global wisdom on selecting and implementing them in low- and middle-income countries.” It draws on lessons learned from several countries to provide evidence and scenarios for low- and middle-income nations to increase the financing potential of national health systems.
Medicaid is a government health insurance program that can be used to offer services in supportive housing programs. Under the new Health Care Reform law, virtually all homeless people will be eligible, and can benefit from configuring supportive housing services to take advantage of Medicaid reimbursement. Consideration will be given to the administrative and data burdens inherited when a housing provider becomes eligible for reimbursement from Medicaid/medical assistance, as well as the benefits of delivering a flexible array of supports to maintain persons in their homes.
How do medicaid waivers expand the possibilities of whole person care 032117Jennifer D.
With the changing landscape in healthcare right now it's important to know how Medicaid Waivers and Whole Person Care can help secure positive outcomes.
AHF started their ACA Workshop with opening remarks from Alliance Healthcare Foundation's Executive Director Nancy Sasaki. Program Officer Sylvia Barron introduced the first presenter, Robin Hodgkin, Director of Imperial County Health Department.
About the Event:
To help those in Imperial County prepare for how the Affordable Care Act will impact work the community, Alliance Healthcare Foundation hosted a workshop on Sept. 11, 2013 at the San Diego Gas & Electric Renewable Energy Resource Center in Imperial County. In this workshop, we explored Covered California enrollment with an overview of multiple health plans and eligibility, discussed the community clinic perspective, and considered its potential impact on the underserved in Imperial County. This workshop was free and included a healthy lunch for all attendees.
Watch the complete event here: http://www.youtube.com/playlist?list=PL-CwI2rkvFSV1_XYs45kGqdJj_R-jfXHP
Medicaid: What You Need to Know (CSH and Foothold)Ronan Martin
In our first session, Foothold Technology Director of Client Services, Paul Rossi and Senior Advisor, David Bucciferro, along with Sue Augustus from CSH, will bring us back to basics of all things Medicaid. They will cover topics ranging in commonly used terms, coverage and eligibility and the differences between Medicaid and Medicare. This webinar series is designed for beginners and experts alike. Beginners will walk away with a strong foundation and experts will have the opportunity to contribute to the conversation.
Chapter 10 Government Health Insurance Programs .docxketurahhazelhurst
Chapter 10:
Government Health Insurance
Programs: Medicaid, CHIP,
and Medicare
Chapter Overview
• Chapter 10 provides a basic overview of the
major public health insurance programs in the
United States, including changes to the
programs under the Affordable Care Act.
• Chapter 10 focuses on:
– Medicaid
– Children’s Health Insurance Program
– Medicare
Entitlements v. Block Grants
• Entitlement: Everyone who is eligible for and
enrolled in the program is legally entitled to receive
benefits from the program. Beneficiaries may not be
refused service for lack of funds or other reasons.
• Block Grants: A defined sum of money (often from
the federal government to the states) that is allocated
for a particular program over a certain amount of
time. Beneficiaries may be refused service for lack of
funds or other reasons.There is no legal entitlement to
the benefits.
Medicaid
• Overview: A federal-state public health insurance
program for the indigent.
• Program administration
– Federal: Center for Medicare and Medicaid
Services (CMS) outlines mandatory and optional
populations and benefits covered under Medicaid
– State: state Medicaid agencies run programs, select
which optional populations and benefits to cover in
the state program
• All states participate in Medicaid
Medicaid – Eligibility
• Medicaid generally covers low-income
• Pregnant women
• Children
• Adults in families with dependent children
• Individuals with disabilities
• Elderly
• Must meet 5 eligibility requirements: Categorical,
Income level, Resources, Residency and Immigration
status
Medicaid — Benefits
• Medicaid covers extensive acute care and Long-Term
Care benefits
– Some benefits are mandatory, others are optional
– Early and Periodic Screening Diagnostic and
Testing services are a comprehensive set of
mandatory services for children
• Deficit Reduction Act of 2006 (DRA) created a new
benefit option that allows states to use one of 5
benchmark or benchmark equivalent options to set
their benefit package
Medicaid — Financing
• Medicaid is jointly financed by the federal and state
governments
• Matching system
– Federal Medical Assistance Percentage determines the
matching rate; rate is tied to each state’s per capita
income with poorer states receive a higher federal
match, and must be at least 50/50
• Beneficiary cost-sharing
– Prior to DRA, very limited cost-sharing allowed
– DRA provides expanded cost-sharing options
Medicaid –
Provider Reimbursement
• Reimbursement levels vary by state and type of
provider
– States have a lot of discretion in setting rates
• Fee-for-service provides paid on a state-determined
fee schedule
• Managed care providers paid according to contracts
between the state and the managed care organization
• Medicaid reimbursement is typically much lower than
private insurance or Medicare reimbursement
Medicaid — Waivers
• States may appl ...
CMS Innovation Center, Center for Medicaid and CHIP Services staff will be hosting a webinar that will discuss how applicants can work with States and the role of States in the Strong Start funding opportunity. A series of follow up webinars will provide more in-depth information about other aspects of this initiative.
More at: http://innovations.cms.gov/resources/Strong-Start-Webinar-State-Partnerships.html
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Health Care Reform and Harm Reduction: Laura Hanen, Rachel McLean - HRC 2010Harm Reduction Coalition
A presentation by Laura Hanen (NASTAD) and Rachel McLean (California Department of Public Health) on what health care reform means for harm reduction and drug user health. Presented at the Harm Reduction Coalition's 8th National Conference, November 18-21, 2010 in Austin, Texas.
Designing Coverage for All - Closing the Coverage Gaps - Joy Johnson WilsonOneVoiceTexas
Joy Johnson Wilson, Health Policy Director at the National Conference of State Legislatures, looks at the coverage gaps at the Designing Healthcare in Texas June 4, 2014 conference.
The world of search engine optimization (SEO) is buzzing with discussions after Google confirmed that around 2,500 leaked internal documents related to its Search feature are indeed authentic. The revelation has sparked significant concerns within the SEO community. The leaked documents were initially reported by SEO experts Rand Fishkin and Mike King, igniting widespread analysis and discourse. For More Info:- https://news.arihantwebtech.com/search-disrupted-googles-leaked-documents-rock-the-seo-world/
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Falcon stands out as a top-tier P2P Invoice Discounting platform in India, bridging esteemed blue-chip companies and eager investors. Our goal is to transform the investment landscape in India by establishing a comprehensive destination for borrowers and investors with diverse profiles and needs, all while minimizing risk. What sets Falcon apart is the elimination of intermediaries such as commercial banks and depository institutions, allowing investors to enjoy higher yields.
Taurus Zodiac Sign_ Personality Traits and Sign Dates.pptxmy Pandit
Explore the world of the Taurus zodiac sign. Learn about their stability, determination, and appreciation for beauty. Discover how Taureans' grounded nature and hardworking mindset define their unique personality.
RMD24 | Retail media: hoe zet je dit in als je geen AH of Unilever bent? Heid...BBPMedia1
Grote partijen zijn al een tijdje onderweg met retail media. Ondertussen worden in dit domein ook de kansen zichtbaar voor andere spelers in de markt. Maar met die kansen ontstaan ook vragen: Zelf retail media worden of erop adverteren? In welke fase van de funnel past het en hoe integreer je het in een mediaplan? Wat is nu precies het verschil met marketplaces en Programmatic ads? In dit half uur beslechten we de dilemma's en krijg je antwoorden op wanneer het voor jou tijd is om de volgende stap te zetten.
Enterprise Excellence is Inclusive Excellence.pdfKaiNexus
Enterprise excellence and inclusive excellence are closely linked, and real-world challenges have shown that both are essential to the success of any organization. To achieve enterprise excellence, organizations must focus on improving their operations and processes while creating an inclusive environment that engages everyone. In this interactive session, the facilitator will highlight commonly established business practices and how they limit our ability to engage everyone every day. More importantly, though, participants will likely gain increased awareness of what we can do differently to maximize enterprise excellence through deliberate inclusion.
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Who might benefit? Anyone and everyone leading folks from the shop floor to top floor.
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What are the main advantages of using HR recruiter services.pdfHumanResourceDimensi1
HR recruiter services offer top talents to companies according to their specific needs. They handle all recruitment tasks from job posting to onboarding and help companies concentrate on their business growth. With their expertise and years of experience, they streamline the hiring process and save time and resources for the company.
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2. Medicare
Provides health insurance
to older adults and certain
people with disabilities
Federal program funded by
two trust funds
Covers acute care services
Does not cover long term
services and supports
(LTSS)
Medicaid
Provides coverage to
people with low-incomes
Joint federal and state
program funded by both
Covers both acute and long
term services and supports
(LTSS)
Medicare and Medicaid Programs
Differ in Funding and Scope of
Services
4. Dual Eligible Beneficiaries Have
Complex Health and LTSS Needs
70.10%
9.20%
14.90%
4.70% 1.10%
US Medicaid Expenditures
on Duals $120.5 Billion
Age 65+
5.9
million
Age <65
3.4
million
Total
Dual
Eligibles:
9 million
US Medicaid Duals
Population
5. Dual Eligible Beneficiaries
Disproportionately Impact Medicaid and
Medicare Spending
US Medicaid Enrollment
Children
28.8 million
49.5%
Adults
14.6 million
25.2%
Other Aged
& Disabled
5.8 million
10%
Dual Eligibles
9 million
15.3%
US Medicaid
Spending
Non-
Duals
61%
Duals
39%
6. Affordable Care Act Created Two Offices
to Address Care and Cost Issues for
Duals
US Department of
Health and Human
Services (HHS)
Centers for Medicare and
Medicaid Services (CMS)
Coordination
Office
Innovation
Center
8. The Center for Medicare and
Medicaid Innovation
The Innovation Center has demonstration
authority to…
• Testing new payment and service delivery models
that fully integrate care for Dual Eligible
Beneficiaries
• Evaluate results of demonstrations and advancing
best practices
• Engaging a broad range of stakeholders to
develop additional demonstrations for testing
9. Financial Alignment and Integrated
Care Demonstrations Are
Beginning
• Six states approved
(June 2013)
• 1 million
beneficiaries
nationwide
• MA focusing on non-
elderly disabled
• WA targeting high-
cost/high-risk
beneficiaries
• CA, IL, OH and VA
focusing on elderly
and disabled
communities
10. Illinois Medicare-Medicaid Alignment
Initiative - Design
• 135,825 beneficiaries
anticipated to participate
• Capitated financial model
• Initiative will last three years
• Voluntaryenrollment beginning
January 2014 (for 6 months)*
• Benefits will include nearly all
Medicare and Medicaid
services
• Unified administration
process
• Improve care coordination
• Integrate financing
11. Illinois Medicare- Medicaid Alignment
Initiative - Goals
• Provide savings
– 1% in first year, 3% in second year; and 5% in
third year
– Managed Care with capitated payment
– Increased care coordination
– Use of HCBS over institutional care
• Improve care
– Decreased emergency room visits
– Reduced hospitalizations
12. Illinois Medicare-Medicaid Alignment
Initiative – Questions
CMS
Illinois Dept.
of
Healthcare
and Family
Services
Managed
Care
Organization
• Specifics to be spelled
out in three-way contracts
between the entities:
– How will beneficiaries be
notified?
– How will plans and
providers meet the needs
of beneficiaries?
– What counseling
assistance will be provided
and by whom?
– What will the sources of
program savings be?
– What grievance and
appeals process will be
available?
13. Prepared by:
Bruce J. Lederman, JD
b: chicagonow.com/aging-in-
chicago/
t: @aginginchicago
Editor's Notes
Medicare-Medicaid Alignment Initiative PlansThank you for joining this brief overview of the Illinois Medicare-Medicaid Alignment Initiative. My name is Bruce Lederman and in this presentation I will review how the health care delivery system for dual eligible beneficiaries in Illinois is being redesigned to become one that is more person-centered with a focus on improved health outcomes while reducing costs growth. With the voluntary enrollment period beginning on January 1, 2014, I believe that you will be hearing more about this demonstration in the coming months. So let’s get started.
Medicare is the federal program that provides health insurance to older adults and certain people with disabilities. It is paid for by two Federal trust funds and covers physician visits, medication costs and hospital and post-acute services. It does not provide for long term services and supports (or LTSS as it is called).Medicaid is a joint federal and state program and it provides health care coverage to people with low incomes who also fall into certain categories such as children, pregnant women, older adults or the disabled. It also pays for long term services and supports. Because Medicaid is funded by a combination of federal and state dollars, eligibility requirements and Medicaid benefits vary among the 50 states.
There are a number of individuals who are beneficiaries of both programs. They are technically referred to a Dual Eligible Beneficiaries and often the shorthand “Duals” is used. There are a variety of reasons why someone would qualify for both programs, but in general either an individual was qualified for Medicaid and became additionally eligible for Medicare once they reached age 65 or at some point after reaching age 65, the individual became eligible for the Medicaid enrollment due to change in their financial resources.Information from Kaiser Health News 2012 Information
The majority of the 9 million Duals are over the age of 65 and are among the sickest individuals covered by either the Medicare or Medicaid programs. These are people with complex health and long term care needs who have their acute medical care expenses paid for by Medicare, while Medicaid covers their premiums and other expenses and for those fully eligible duals who meet asset and income thresholds their long term services and supports needs are also paid for by Medicaid.In it’s annual report to Congress the Medicare Advisory Payment Commission noted that because the Medicare and Medicaid programs have different regulatory and reimbursement schemes, current coverage and payment policies for duals incentivizes cost shifting and hinders efforts to improve quality and coordination of care. In 2010 there were approximately 338,000 Duals in Illinois and Illinois Medicaid expenditures for this population mirrors the national Medicaid data shown on the slide. Source, Urban Institute 2010
On the national level Duals comprise 15% of those enrolled Medicaid enrollment, but are responsible for 39% of spending for that program. Similarly this disparity also in the Medicare program where Duals only constitute 16% of Medicare enrollment, but are responsible for 25% of Medicare spending. Half of the Medicare Duals are in fair or poor health, and that is more than twice the rate of other Medicare beneficiaries.As a group, Duals are more likely to have mental health needs, more likely to have less than a high school education and are more than twice as likely to be a member of a minority population. Here is something to consider, Duals are seven times more likely to be a long term care resident than non Dual Medicare beneficiaries.
So in response, the legislation creating the ACA included the creation of two new federal offices to explore how to improve access and delivery to care and control growth in spending: the Federal Coordinated Health Care Office (Coordination or Duals Office) and the Center for Medicare and Medicaid Innovation (also known as the Innovation Center). with Medicare and Medicaid expenditures as % of GDP expected to double in the next 25 years,
The coordination office seeks to improve the alignment of care between the two programs to improve quality and lower the cost of care to dually eligible beneficiaries by funding state Demonstrations.It is projected that in the next 25 years, Medicare and Medicaid expenditures will double as a percentage of GDP. The hope is that the demonstrations funded by the Coordination office, will produce interventions to impact this trend.
While the folks at the Coordination Office are keeping busy aligning the Medicare and Medicaid programs, the Innovation Center is busy developing new payment and service delivery models and is currently funding 28 states to implement strategies for payment reform.
One of the Innovation Center’s new payment and service delivery models that fully integrate care for Dual Eligible Beneficiaries is the, cleverly named, financial alignment and integrated demonstration. Six states are approved and this demonstration will last for 3 years and enrollment will eventually grow to two million nationally. CA, IL, OH, VA and MA will test a capitated payment model of reimbursement and WA will test a FFS model.In Illinois there are 1.9 million Medicare beneficiaries (2010) and 338,582 Duals (or 19% of all Medicare beneficiaries).In Illinois there were 2.8 million enrolled in Medicaid (2010) Duals are 25% of the Medicaid Spending
Voluntary enrollment in the Illinois initiative is scheduled to begin on January 1 and some consider this an ambitious goal and have suggested that Illinois should follow the recent example of California, which decided to delay enrollment in its own Alignment initiative for four months.The goals of this demonstration mirror those of others around the country: One To unify the administration process so dual will seamlessly be able to enroll and disenroll in both programs with a single appeal process.Two. To improve care coordination between the two programs to avoid unmet needs and underutilization of community based services and Three – integrate financing to facilitate care coordination.
There are many questions as to the source of these savings…Illinois currently has one of the highest rates of potentially avoidable hospital admissions nationally and;Illinois has one of the highest proportions of spending on institutional services compared to HCBS.
How much money can really be saved?Will managed care organizations be able to fully coordinate the complex needs of this challenging population?Will community-based organizations be able to participate fully in their traditional role as care providers?There are among the many questions that community-based providers of LTSS and elder advocates have for the Illinois Department of Healthcare and Family Services.