ACAP Plans and the Duals Demonstrations: Early Progress, Innovations and Challenges
In 2013, the Centers for Medicare & Medicaid Services (CMS) began implementation of a series of demonstration projects to test new models of care coordination and financing for people who were dually eligible for Medicare and Medicaid benefits. Dual-eligible beneficiaries are frequently among the costliest beneficiaries in either Medicare or Medicaid, and are often lost in the gaps between both programs.
To bridge these gaps, new Financial Alignment Demonstrations (or “duals demonstrations”) were created by the Affordable Care Act to improve care coordination and outcomes, implement new care delivery systems for beneficiaries, and generate savings to the Medicare and Medicaid programs. The duals demonstrations are astep further towards integration compared with dual-eligible special needs plans (D-SNPs). While D-SNPs are required to cover some, but not all, Medicaid benefits, demonstration plans are required to integrate all Medicare
and Medicaid benefits. The demonstrations also test passive enrollment of dual eligibles into health plans for their Medicare benefits, and attempt to align certain Medicare and Medicaid requirements and administrative processes.