Medicare-Medicaid Coordination Focus of New HHS Initiative

The U.S. Department of Health and Human Services (HHS) announced Wednesday a series of initiatives to improve access to Medicare data and better coordinate healthcare between Medicare and Medicaid. The initiatives will be led by the new Federal Coordinated Health Care Office (the Medicare-Medicaid Coordination Office), which was created by the Affordable Care Act to help make the two programs work together more effectively with the objective of improving patient care and lowering costs.

“Medicaid costs are largely driven by the complex medical needs of low-income seniors and people with disabilities who are eligible for both Medicare and Medicaid,” said Donald Berwick, administrator of the Centers for Medicare & Medicaid Services, in a release. “We know that by working together, we can provide better, more coordinated care while lowering healthcare costs and saving money for states.”

Currently, 60 percent of Medicare-Medicaid enrollees—or “dual eligibles”—have multiple chronic conditions and 43 percent have at least one mental or cognitive impairment. While only 15 percent of Medicaid enrollees are also Medicare beneficiaries, Medicare-Medicaid enrollees represented 39 percent of Medicaid spending in 2007. Medicaid spent about $120 billion on this group—about twice as much as Medicaid spent on the 29 million children it covered. The Medicaid spending per Medicare-Medicaid enrollee was $15,459 in 2007, more six times higher than the comparable cost of a non-disabled adult Medicaid-only enrollee ($2,541).

The Medicare-Medicaid Coordination Office has launched the Alignment Initiative, an effort to more effectively integrate benefits under the two programs. A lack of alignment between the programs can lead to fragmented or episodic care for people with both Medicare and Medicaid coverage, which can reduce quality and raise costs.

The Medicare-Medicaid Coordination Office is seeking input and ideas about how to align in six areas: care coordination, fee-for-service benefits, prescription drugs, cost sharing, enrollment and appeals.

A notice for public comment on the Alignment Initiative will be displayed in the Federal Register. The notice requests public input on priorities and key goals, and individuals July 11 to submit comments.

Medicare data access

HHS announced a new process that provides faster state access to Medicare data to support care coordination. Access to Medicare data is an essential tool for states seeking to coordinate care, improve quality, and control costs for their highest cost beneficiaries, according to CMS. With Medicare data, states can identify high-risk and high-cost individuals, determine their primary health risks and provide comprehensive individual client profiles to its care management contractor to tailor interventions.

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