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Assessing ACAP Plan Efforts to Coordinate Care for Dual Eligibles With Chronic Conditions

On the eve of a Senate Finance Committee hearing on ways to improve care for chronically ill Medicare beneficiaries, ACAP Chief Executive Officer Margaret A. Murray noted the progress of ACAP-member Safety Net Health Plans offering coverage through Special Needs Plans and in Financial Alignment Demonstrations:

 “Under the duals demonstrations, health plans are already innovating, and enrollees are seeing the benefits. Some plans are working with community-based organizations to connect members to stable housing after they emerge from stays in nursing facilities. Others are opening regional primary care centers for dual eligibles who didn’t have a regular or meaningful relationship with a primary care provider before joining the demonstration... We are commited to continuing our work on ways to improve the design and implementation of the Duals Demonstration and the sustainability of integrated care programs for dual-eligible beneficiaries.” 

Fact Sheet >   Statement >   Letter to Senate Finance Committee >

ACAP Applauds Steps to Consider Full-Benefit, Partial-Benefit Dual Eligibles Separately 

In a recent statement on the 2016 Rate Announcement and Final Call Letter issued by the Centers for Medicare & Medicaid Services, ACAP CEO Margaret A. Murray voiced support for CMS's decision to consider accounting for full-benefit and partial-benefit dual eligibles separately in risk adjustment calculations. "We’re pleased that CMS directly addressed one of the concerns we raised in our comment letter by exploring treating full-benefit and partial-benefit dual eligibles separately in the risk-adjustment model. This change alone will improve the accuracy of payments to [Dual Eligible Special Needs Plans] that serve chronically ill and vulnerable populations." Statement >

ACAP Commends Congress for Ending Annual "Doc Fix" Ritual

ACAP CEO Margaret A. Murray expressed support for Congressional passage of the Medicare Access and CHIP Reauthorization Act of 2015. "The string of eleventh-hour “doc fix” agreements that had been part and parcel of the SGR was a disservice to physicians who served Medicare beneficiaries. Leaders of both parties in the House and Senate deserve significant credit for working in a bipartisan way to bring this practice to an end."  Statement >

4 in 10 Marketplace Issuers Offer a Medicaid Plan in the Same State; Featured in Georgetown CCF Blog

An ACAP study finds that nearly 4 in 10 organizations that offer coverage through Qualified Health Plans (QHP) in public Health Insurance Marketplaces operate a Medicaid managed care plan in the same state, providing an opportunity for consumers with low incomes to select a source of coverage that may remain continuous. Such plans may also provide a single source of coverage to families with ‘split eligibility’—where, for instance, parents may be eligible for subsidized Marketplace coverage while their children are eligible for Medicaid or CHIP. Issue Brief >    Spreadsheet > 

A March 23 post on A Children's Health Policy Blog authored by Meg Murray and Jennifer Babcock ties the findings of the brief to policies aimed at maximizing the benefits of "overlap issuers."  Blog >

New Report Profiles Safety Net Health Plan Care Coordination Initiatives

A new ACAP fact sheet examines programs from four Safety Net Health Plans aimed at improving ways in which health plans coordinate care for specific populations in their membership. Care coordination is a hallmark of managed care in general, and Safety Net Health Plans in particular. Many Medicaid MCOs have devoted substantial resources to better organize the way care is delivered—especially to members who have a current or future high level of medical need. The paper was authored by The Menges Group.

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