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Duals Project Approved in Washington State

By Rebecca Adams, CQ HealthBeat Associate Editor

October 26, 2012 -- The Centers for Medicare and Medicaid Services(CMS) has approved its first managed fee-for-service demonstration in Washington state for people who are dually eligible for Medicaid and Medicare.

The CMS duals demonstration will launch in Washington state April 1, 2013, and continue until December 31, 2016. The goal of the project is to better coordinate the care of people who are eligible for both programs.

Nationally, the duals demonstration is an effort to allow states to experiment with different ways to better align the Medicare and Medicaid programs through managed care or managed fee-for-service. A total of 26 states have asked to participate.

Washington is the second state that CMS officials have given a green light to proceed. The first was Massachusetts—a managed care pilot that was approved two months ago.

The nationwide duals demonstration project has been controversial from the start, particularly the managed care aspect. A variety of policy experts and stakeholders, including the Medicare Payment Advisory Commission (MedPAC), have raised questions about whether the demonstration will involve too many patients or move too quickly. Some lawmakers worry that beneficiaries could be confused by changes.

CMS officials have approved just part of Washington state’s request so far and are still considering a plan to expand managed care for dually eligible beneficiaries in the state.

Supporters of the overall demonstration effort throughout the nation say that the status quo for dually eligible people is unacceptable because these patients may not have anyone coordinating care for their complex treatment needs. In many instances, they have a number of doctors and take a long list of medications, which can leave them vulnerable to dangerous drug interactions or unnecessary services. The fragmented care could mean that they don’t get preventive care that they need.

Under the approved initiative, patients can choose to enroll in a medical home that will be designed to coordinate all of the care that a beneficiary gets—including medical, mental health, substance use treatment, long-term services, and other social services such as housing and food assistance. Providers are expected to follow up after a patient has been in a medical facility, such as a hospital, and check on issues such as whether the beneficiary is taking his or her medication properly.

The so-called dual eligible population of beneficiaries in Washington is about 115,000 people as of June 2011. About 65,000 are people who are 65 or older and 50,000 are persons with disabilities under the age of 65. The demonstration is expected to operate in all but three counties in the state (King, Snohomish, and Whatcom counties, where the state is pursuing the managed care model allowed under the duals initiative). The state can expand its managed fee-for-service effort to those three counties anytime before Nov. 1, 2013.

Washington demonstrated its interest in the duals demonstration early on. It is one of 15 states that received an 18-month planning grant from CMS to develop a design and implementation plan for service delivery models that integrate care for people who are dually eligible for Medicare and Medicaid.

Rebecca Adams can be reached at [email protected].

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