I was just beginning to believe that the states, CMS and the health policy community were finally recognizing a larger scale opportunity for managed care to integrate Medicare and Medicaid funding and care for the most expensive and vulnerable beneficiaries, thus reducing costs and improving quality.
After decades of demonstration projects and waivers, a discussion at the Alliance for Health Reform yesterday revealed that only 250,000 dual beneficiaries are enrolled in integrated delivery systems where the services and funding streams are coordinated around the patient and not the payer. Even Medicare Advantage plans including Special Needs Plans have had difficulty working with state Medicaid agencies to get full funding for services under both programs. Now the light bulb has gone off as states are seeing managed long term care services and supports and shifting duals into managed care as a significant solution to Medicaid budget woes.
I remember discussions at CMS where the difficulties of integrating the funding streams was stymied by political issues with state vs. federal control. And yesterday the Robert Wood Johnson Foundation and the Urban Institute recommended that Medicare should take the lead for dual eligibles in recognition that the federal government already finances most of the care costs and has the most to gain with improved integration of care and care coordination.