ACAP-Commissioned Paper Proposes New Model of Care, Financing for Dually Eligible Beneficiaries
A new paper commissioned by ACAP and written by researchers from the George Washington University School of Public Health & Health Services outlines a new proposal for providing care to individuals eligible for both Medicare and Medicaid, or “dual eligibles.”
The paper, by Jane Hyatt Thorpe, J.D. and Katherine Jett Hayes, J.D. of George Washington University outlines a new state plan option where states would choose qualified health plans to provide highly integrated care services for dual eligibles under a framework of beneficiary protections and standards for financial integrity set by the Federal government.
While dual eligibles number only about 9 million, they account for 36 percent of all Medicare spending and 39 percent of Medicaid spending. Care for duals is costly in part because duals are more likely to live with chronic conditions or mental illness, and are more likely to need continuous care.
The new state plan option, which ACAP has dubbed the Very Integrated Program (VIP), would be a distinct, permanent program featuring a fully-integrated, capitated model of care that can be chosen by states through a permanent choice within the Medicaid State Plan. States would contract with managed care organizations (MCOs) to provide care for dual eligibles, while CMS would set standards for strong patient protections covering areas including participant rights, eligibility, application procedures, administrative requirements, services, payment, quality assurance, and marketing guidelines.
Read the proposal | Executive summary | Press Release | Slides
ACAP hosted a conference call that explored the proposal in more detail. To listen to an archived recording, dial toll-free 1-888-203-1112, replay passcode 76253237. The replay is available through March 10.
ACAP Weighs In on Wide Range of Proposed Regulations
October 31 marked the due date for comments on a wide range of proposed CMS regulations, ranging from implementation of Exchanges to determination of eligibility for Medicaid, premium tax credits and risk adjustment methodologies. With input from its members, ACAP commented on each of eight proposed regulations or requests for information over the past two months.
A number of general themes emerged from the comments, including affordability, program sustainability, continuity of care, reducing barriers to Safety Net Health Plan participation in Exchanges, and making eligibility determinations in a way that applicants find no “wrong door.”
Review a summary of ACAP’s recent comments, or download them all through the Regulations and Comments page.
Safety Net Health Plans Ready Provider Networks for 2014 Expansion of Medicaid Eligibility: Results From an ACAP Survey
A new ACAP fact sheet assesses the efforts of Safety Net Health Plans to maintain strong provider networks as their enrollments are set to rise as Medicaid expands its eligibility criteria in 2014 under the Affordable Care Act.
While the Affordable Care Act extends eligibility for Medicaid coverage for individuals with income up to 133 percent of the federal poverty level in 2014, Safety Net Health Plans serving these populations must have networks of sufficient primary care and specialty providers to deliver needed care to expanded membership.
New Report: The Basic Health Program Could Dramatically Lower Premiums, Out-of-Pocket Costs for People with Low Incomes, Reduce Uninsured by 600,000
A new report from the Urban Institute commissioned by ACAP suggests that the Basic Health Program (BHP), an option for states created by the Affordable Care Act that would provide coverage to low-income Americans, could make health care more affordable for more than 5 million Americans and reduce the ranks of the uninsured by an additional 600,000 if this little-known feature of health reform were to be implemented by all states.
Under BHP, states could provide health coverage to people with incomes up to 200 percent of the federal poverty level who do not qualify for coverage through Medicare, Medicaid or the Children’s Health Insurance Program (CHIP). The state would contract with health plans or providers to provide coverage in lieu of offering them subsidized coverage through health insurance Exchanges. States implementing BHP would receive 95 percent of their estimated tax credits and subsidies for the Exchange from the Federal government.
Read: Full report (PDF) | Presentation | Audio Recording | Press statement
Once Again, Five of the Nation's Top Ten Medicaid Plans Are Safety Net Health Plans
Rankings from the National Committee for Quality Assurance, a leading independent health care quality organization, has shown that for the second consecutive year, ACAP-member Safety Net Health Plans make up half of the top ten Medicaid plans in the country. Read ACAP's press release, or see the full rankings.
Margaret Murray Featured in Dec 2010 Managed Healthcare Executive
ACAP CEO Margaret Murray was featured on the cover of the December 2010 Issue of Managed Healthcare Executive.
Inside, she discusses ACAP, health care reform, and emerging opportunities for Safety Net Health Plans.
Click here to access the interview online.