In this section you can find profiles of each state including the number of dual eligibles who live there and the type of integrated care model the state is considering. Links to state websites on dual eligibles are included if available.
California
(see California tab for more detailed information)
Signed MOU and Three-Way Contract
(1.2 million duals)
Capitated-Managed Care Model and/or Managed Fee-for-Service Model
California contracts with risk-based private managed care organizations to provide services in exchange for capitated payments in six counties.
State website: www.calduals.org
California MOU | MOU Fact Sheet
Justice in Aging’s Summary of the CA MOU
California Three-Way Contract for Subcontracted Plans
Quality Withhold Analysis Report for 2014 (Released 2017)
Colorado
MOU Signed, Three-Way Contract Signed
DEMO Ending December 31, 2017
(48,000 duals)
Managed Fee-for-Service Model (AC0)
Colorado proposes to enroll about 30,000 dual eligibles (half its dual population) into Colorado’s Accountable Care Collaborative, a hybrid of a primary care medical home and an ACO. The pilot will be statewide.
State website: https://www.colorado.gov/pacific/hcpf/accountable-care-collaborative-acc-medicare-medicaid-program
Illinois
Signed MOU and Three-Way Contract
(659,800 duals)
Capitated-Managed Care Model and/or Managed Fee-for-Service Model
State website: https://www.illinois.gov/hfs/MedicalProviders/cc/mmai/Pages/default.aspx
NSCLC’s Summary of the Illinois MOU
Illinois Three-Way Contract (original)
Illinois Three-Way Contract (Aug 2016)
Summary of Contract Changes (2016)
Massachusetts
Signed MOU and Three-Way Contract
(245,248 duals)
Capitated-Managed Care Model
Massachusetts is proposing to use Integrated Care Organizations (ICOs), which will either be insurance-based or provider-based health organizations. Available statewide to full duals aged 21 to 64, opt-out enrollment. Particular emphasis on meeting behavioral health needs.
State website: www.mass.gov/masshealth/duals
Memorandum of Understanding (MOU)
Justice in Aging’s summary of the MOU
Three-way Contract for Massachusetts Demonstration
Three-way Contract for Massachusetts Summary of Beneficiary Protections
Three-Way Contract Amendment (2016)
Summary of Contract Language (2016)
Massachusetts One Care Ombudsman
Michigan
Signed MOU and Three Way Contract
(100,000 dual eligible individuals)
Capitated-Managed Care Model
Michigan proposes a capitated model using risk-based managed care plans, ACO’s and other capitated entities. Target population is all dual eligibles statewide. Opt out enrollment.
State website: http://www.michigan.gov/mdch/0,4612,7-132-2945_64077-335999–,00.html
Michigan Readiness Review Tool
Three-Way Contract Update (2016)
Summary of Contract Changes (2016)
Minnesota
Signed MOU
(123,575 duals)
Capitated-Managed Care Model
Minnesota proposes a shared savings model using D-SNPs with waivers from certain current SNP requirements, as well as improvements to current initiatives including implementation of Health Care Homes (HCH) and provider level payment systems such as accountable care organizations (ACOs) and Total Cost of Care payment models. All full dual eligibles statewide with estimated enrollment of 54,300, most of whom will be seniors already enrolled in D-SNPs.
State website: www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_163573
New York
Signed MOU and Three Way Contract.
Withdrew managed FFS proposal (March 2013).
(691,036 duals)
Capitated-Managed Care Model
New York is proposing a capitated managed care model for New York City building on its Medicaid long term care program. Approach will be phased with projected eventual statewide enrollment of all duals.
State website: www.health.ny.gov/health_care/medicaid/redesign/managed_ltc_workgroup.htm
Letter from the Office of Health Insurance Programs to MMCO explaining decision not to pursue demonstration.
FIDA IDD Readiness Review Tool
Ohio
Signed MOU and Three-Way Contract
(290,533 duals)
Capitated-Managed Care Model
State website: http://www.healthtransformation.ohio.gov/CurrentInitiatives/IntegrateMedicareMedicaidbenefits.aspx
Integrated Care Delivery Plans Selected
Justice in Aging‘s Ohio MOU Summary
Readiness Review
Rhode Island
Signed MOU and Three-Way Contract
(35,707 duals)
Capitated-Managed Care Model
State website: http://www.eohhs.ri.gov/IntegratedCare.aspx
South Carolina
Signed MOU and Three-Way Contract
(134,673 duals)
Capitated-Managed Care Model and/or Managed Fee-for-Service Model
South Carolina is proposing an integrated care model that would use the new Health Home option in ACA. Enrollment with an opt-out option to HCBS or FFS. The target population is dual eligibles with major diagnostic mental disorders or Alzheimer’s.
State website: https://msp.scdhhs.gov/SCDue2/
South Carolina Three-Way Contract
Texas
Signed MOU and Three-Way Contract
(593,576 duals)
Capitated-Managed Care Model
State website: https://hhs.texas.gov/services/health/medicaid-chip/programs/texas-dual-eligible-integrated-care-project
Virginia
Signed MOU and Three-Way Contract
DEMO Ending 2017
(164,279 duals)
Capitated-Managed Care Model
State website: http://dmasva.dmas.virginia.gov/Content_pgs/altc-enrl.aspx
Virginia Poverty Law Center: MOU Comments
Virginia Advocate Comments to DMAS on the Massachusetts Contract
Justice in Aging‘s Virginia MOU Summary
Commonwealth Coordinated Care Rate Development Process
Quality Withhold Analysis Report for 2014 (released 2017)
Washington
Signed MOU for Managed FFS (April 2013). Cancelled Capitated Model (February 2015).
(48,000: 21,000 in MFFS, 27,000 capitated)
Capitated and Managed Fee for Service Model
Washington will utilize both a capitated model and a managed fee-for-service demonstration. Under the capitated demonstration, 27,000 dual eligible individuals in King and Snohimish Counties will be eligible to enroll into private managed care plans that will manage Medicare and Medicaid Services. Voluntary enrollment is scheduled to begin no earlier than July 1, 2014, and passive enrollment will not begin any earlier than September 1, 2014.
Washington was the first state to implement a managed fee-for-service model on July 1, 2013. The managed fee-for-service relies on a Health Home Lead Entity (HHLE) who subcontract with a Health Home Coordinated Care Organization (HCCO) to coordinate the health home services.
State website: http://www.adsa.dshs.wa.gov/duals/
Memorandum of Understanding (MFFS)
Memorandum of Understanding (Capitated)
Final Demonstration Agreement (MFFS)
Final Demonstration Agreement Amendment
Justice in Aging‘s Summary of the MOU
First Annual Report (MFFS)
CMS Dual Eligible Enrollee State Profiles,
http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/StateProfiles.html