Mathematica Policy Research has released a brief examining managed long-term care.  Focusing on options for New York State, the brief also offers general options available to all states.  The authors also offer options for improving dual eligibles' care.

From the report:

The Federal Coordinated Health Care Office (renamed the Medicare-Medicaid Coordination Office) and the Center for Medicare and Medicaid Innovation are partnering to help states develop integrated care programs for dual eligibles.  CMS selected 15 states on April 14, 2011 to receive contracts of up to $1 million each to help them plan dual eligible demonstration projects.  States selected were CA, CO, CT, MA, MI, MN, NY, NC, OK, OR, SC, TN, VT, WA, and WI.  Planning contracts will be for 18 months, and demonstrations will start in 2012.

Full report: Managed Long Term Care: Options for New York and Examples From Other States (PDF | 197.47 KB)

Mathematica Policy Research.  (2011).  Managed long term care: options for New York and examples from other states.  Verdier, J.

Mathematica Policy Research has released a brief examining opportunities to improve dual eligibles' care through managed care plans in Medicare.  The authors offer background on dual eligibles and state efforts to manage their care.  The brief also examines opportunities for expanding managed care for dual eligibles under the national health care reform law.

From the report:

Only July 8, 2011, CMS announced three new initiatives to assist states in improving care for dual eligibles.  Two new financial models to support state efforts to coordinate care for dual eligibles.  A capitated model in which a state, CMS, and a health plan enter into a three-way contract, and the plan receives a prospective blended payment to provide comprehensive, coordinated care.  A managed fee-for-service model in which a state and CMS enter into an agreement that would permit the state to share in Medicare savings for care coordination initiatives.

Full report: Improving Care for Dual Eligibles: Opportunities for Medicare Managed Care Plans (PDF | 183.71 KB)

Mathematica Policy Research.  (2011).  Improving care for dual eligibles: opportunities for Medicare managed care plans.  Verdier, J.

On July 21, the American Action Forum (AAF) released a report, examining the effect of providing drug rebates similar to those employed in Medicaid to dual eligibles and beneficiaries of the Medicare Prescription Drug Benefit Program (Part D) Low-Income Subsidy (LIS). Legislation (S. 1206) to enact such a change is currently before the Senate Finance Committee, with supportive legislators arguing that it would save $112 billion over 10 years. However, the AAF report contends that the change would result in Part D premium increases of up to 40 percent and argues that drug manufacturers may shift drug costs to the private health coverage market in response to the rebates.

From the report:

The Medicare Part D prescription drug program marked a significant change to Medicare. Part D created a competitive market for prescription drug plans, and has proven to be a dramatic success in controlling prescription drug costs. Actual Part D benefit costs have been in the vicinity of 40 percent below the Congressional Budget Office’s initial ten-year estimate. As a result, America’s seniors have benefited from lower prescription drug premiums. The voluntary outpatient drug benefit is delivered through stand-alone prescription drug plans (PDPs) and drug plans sponsored by Medicare Advantage plans (MA-PDs) that compete head-to-head in each geographic region, without a government-prescribed benchmark or price-setting mechanism. Every Part D plan participates in the annual bidding process that determines the federal subsidy to enrollees, which averages 74.5 percent of the cost of a standard benefit.

Full report: Cost Shifting Debt Reduction to America’s Seniors: Medicare Part D Rebates Would Dramatically Increase Drug Premiums (PDF | 419 KB)

American Action Forum. (2011). Cost shifting debt reduction to america’s seniors: Medicare Part D rebates would dramatically increase drug premiums. Holtz-Eakin, Douglas and Ramlet, Michael. 

The Kaiser Family Foundation has released a brief examining aspects of the national health care reform law affecting dual eligibles.  The authors note that the law offers measures to improve care quality and reduce costs.  The brief suggests that doing so is critical because dual eligibles comprise 15 percent of the Medicaid-covered population but represent 39 percent of Medicaid spending, and comprise 21 percent of the Medicare-covered population but represent 36 percent of Medicare spending.  The authors outline how the law improves care integration, requires improved quality, and increases access to home and community-based long-term services and supports.

From the report:

There are 9 million Medicaid beneficiaries who are “dual eligibles”—low-income seniors and younger persons with disabilities who are enrolled in both the Medicaid and Medicare programs. The Affordable Care Act (ACA) includes a number of provisions aimed at improving care and streamlining service delivery for dually eligible Medicaid and Medicare beneficiaries. Dual eligibles are among the sickest and poorest individuals covered by either the Medicaid or Medicare programs; they comprise only 15 percent of total Medicaid enrollment yet represent 39 percent of annual Medicaid expenditures. Similarly for Medicare, duals represent 21 percent of Medicare enrollees but 36 percent of Medicare expenditures. Dual eligibles’ care needs are served through both the Medicare and Medicaid programs. Medicare primarily pays for acute and hospital care, and prescription drugs, while Medicaid generally helps to pay for Medicare premiums, cost sharing and long-term care, as well as other non-medical services. 

Full report: Affordable Care Act Provisions Relating to the Care of Dually Eligible Medicare and Medicaid Beneficiaries (PDF | 300.90 KB)

Kaiser Family Foundation.  (2011).   Affordable Care Act provisions relating to the care of dually eligible Medicare and Medicaid beneficiaries. 

On May 26, the Kaiser Family Foundation released a brief examining Medicaid's role in covering dual eligibles.  Noting that nearly 9 million individuals are dually eligible for Medicare and Medicaid, the brief explains why this population needs Medicaid coverage and what services they receive under it.  The authors also project the impact of the national health care reform law on dual eligibles.

From the report:

Nearly 9 million Medicaid beneficiaries are “dual eligibles”- low-income seniors and younger persons with disabilities who are enrolled in both the Medicare and Medicaid programs. Dual eligibles are among the sickest and poorest individuals covered by either the Medicaid or Medicare programs. They must navigate both Medicare and Medicaid to access services, and rely on Medicaid to pay Medicare premiums and cost-sharing and to cover critical benefits Medicare does not cover, such as long-term care. Because dual eligibles have significant medical needs and a much higher per capita cost than other beneficiaries, they are of great interest to both Medicare and Medicaid policymakers and to the state and federal governments that fund and manage the programs.

Full report: Dual Eligibles: Medicaid's Role for Low-Income Medicare Beneficiaries (PDF | 200.68 kb)

Kaiser Family Foundation.  (2011).  Dual eligibles: Medicaid's role for low-income Medicare beneficiaries.