Massachusetts has become the first state to turn coordination of healthcare for its low-income and disabled adults over to state-contracted insurers/organizations. A new program, created under the federal Affordable Care Act, was approved by Governor Patrick on August 23, 2012, for individuals (ages 21 to 64) who currently qualify for both Medicare and Medicaid (also known as "dual eligibles"). The Boston Globe covered this news in the story "State signs on to health program for disabled adults" by Chelsea Conaboy (Health & Wellness section dated 08/23/2012). Approximately 110,000 patients across the Commonwealth who are currently covered by both programs, will be signed on with these agencies that will oversee delivery of their medical, mental health and long-term care. At this time, the state is taking bids from organizations for these services. Once this process has been completed, coverage under the program is expected to start in April 2013. Currently, it is reported that dual eligibles would be given the choice to opt out, or otherwise they will be enrolled in an organization within their county. It is not clear what the consequences might be for those who do not go along.
The US Centers for Medicare & Medicaid Services (CMS) and the Commonwealth of Massachusetts Executive Office of Health and Human Services (EOHHS) Office of Medicaid (MassHealth) have worked on this project since last year. It is called the new Integrated Care model for Dual Eligible adults. Funding for their Medicare and Medicaid programs would be combined. The Massachusetts EOHHS Office of Medicaid asserts in the overview of this model that the benefits "would significantly improve the alignment of financial incentives and improve provider accountability by making a Global Payment for all Medicare and Medicaid services, a broader continuum of behavioral health services, and Community Support Services." (The link to the complete EOHHS overview is provided at the end of this article.)
Dual eligible care coordination is something new and even though policy makers seem eager to cut down costs, others are quite concerned about the little experience and data that comes with this sort of healthcare management. Several articles were published by Health Affairs (a leading peer-reviewed journal of health policy thought and research) over this past summer on this topic. Managed care for dual eligibles is under consideration by twenty-four states and the District of Columbia. In general, caution is urged about making hasty moves of patients into managed care programs, especially without resources and infrastructure in place. The Boston Globe conveyed similar apprehension regarding the rapid implementation of this program shared by representatives from several Massachusetts home-based care networks, consumer groups and agencies serving the elderly.
For more information
Integrating Medicare and Medicaid Overview (Mass.gov) Outline of a new program that the Massachusetts Executive Office of Health and Human Services (EOHHS) Office of Medicaid (MassHealth) is developing by which to integrate Medicare and Medicaid for individuals who meet requirements for both programs (also known as Dual Eligible).
Resistance builds to managed care for dual eligibles (American Medical News published by the American Medical Association, 04/09/2012) Groups of physicians speak out as managed care for dual eligibles gains momentum in twenty-four states and the District of Columbia.
"State signs on to health program for disabled adults" by Chelsea Conaboy, published in the Boston Globe, 08/23/2012 (Source: http://bostonglobe.com/lifestyle/health-wellness/2012/08/23/state-signs-health-program-for-disabled-adults/6CcXjHPTcH0fnlS2iKaJdP/story.html)
Addendum: In a follow-up article, "State names six organizations to oversee health care for neediest adults" by Chelsea Conaboy, published 11/12/2012 (White Coat Notes for Boston.com) the organizations that will oversee dual-eligible patients in Massachusetts are identified as: Network Health (serving the entire state, but the only agency available in Dukes and Nantucket counties); Blue Cross Blue Shield of Massachusetts; Boston Medical Center HealthNet Plan; Commonwealth Care Alliance; Fallon Total Care; and, Neighborhood Health Plan. The availability of these organizations may from county to county. (Source: http://www.boston.com/whitecoatnotes/2012/11/12/state-names-six-organizations-oversee-health-care-for-neediest-adults/sfsk1NZvHSvPVqWRoI1aRL/story.html )