Scott LeitzAssistant Commissioner for Health Care

Minnesota Department of Human Services

Minnesota’s Approach: Integrated Medicare & Medicaid

Programs

Alliance for Health ReformBriefing on Dual Eligibles

June 3, 2011

MN’s Dually Eligible Population 106,600 Minnesotans are fully eligible for both Medicare

and Medicaid 97% of seniors and 50% of people with disabilities on

Medicaid are dually eligible About 40% of MN’s total Medicaid spending is for duals 68% of seniors and 41% of people with disabilities in

MN Medicaid receive long-term care services Most seniors served through managed care

Minnesota SeniorCare Plus (MSC+) Minnesota Senior Health Options (MSHO): SNP

program, voluntary alternative to MSC+ Most people with disabilities served through FFS

Special Needs BasicCare (SNBC): SNP program, voluntary alternative to FFS

Key Service Needs of Duals Aligned financial incentives between payers

(Medicare and Medicaid) and providers Primary and chronic care management strategies

implemented across care settings Improved coordination between primary, acute and

long-term care services Aligned networks across Medicare and Medicaid

providers Navigation assistance to get to right providers at

the right time Simplified paperwork and member materials that

explain Medicare and Medicaid services and how they fit together

Coordination with behavioral and housing needs

Distinct Population IssuesFor seniors: Many opportunities for reducing hospitalization but savings accrue to MedicareDiversion strategies from nursing homes and high costs community settings (assisted living)

For people with disabilities:High use of specialty care but lack of access to basic primary and preventive care Many primary care providers unwilling or lack expertise to serve people with disabilities Majority have co-occurring mental health diagnosesNot a static population: people with disabilities constantly becoming dual after Medicare waiting period results in continuity of care issues

Primary Issues Facing States Medicare-paid providers drive primary and acute

care. If poorly managed, Medicaid pays for the result (Higher need for long-term care services)

Increased pressure on State budgets due to high growth in dual eligible populations; need to prepare for both fiscal and care delivery challenges

Lack of financial equity for States for investment in aligned/integrated options (immediate savings accrue to Medicare)

Lack of stable scale-able platforms for alignment of Medicaid and Medicare for the future

Access to Medicare data for total cost of care requires State resource investment

Minnesota’s Approach First state to integrate Medicare and Medicaid

primary, acute and long-term care for seniors

Transitioned from Medicare demo to SNP status in 2005

No complex waivers needed; we use existing state plan and home and community based service authorities under 1915 (a) and (c ).

Close working relationship and ongoing understanding and support from CMS (both Medicare and Medicaid) have been very important

Stakeholder involvement key in acceptance of managed care approach for people with disabilities

Where We’ve Succeeded SNPs aligned with State long-term care goals for

improved access and cost management Majority of seniors now served in community 98% of seniors on MSHO now receive annual

primary/preventive care visits State has leveraged integrated Medicare data and

coverage of additional care coordination through contracts with Medicare SNPs

Continued enrollment growth in current integrated program for people with disabilities (SNBC) despite loss of some SNPs

Creative environment has produced some total cost of care models (virtual) that manage across payers and domains of care

Not Without Challenges Limited opportunity for State to share any

Medicare and Medicare SNP savings under current models

SNP bid process has resulted in premiums that duals cannot pay and thus lack of stability in SNP participation in integrated programs

Need to stabilize current SNP platform for integration and make it more attractive to States

Need for improvement in Medicare risk adjustment for frail seniors and people with disabilities

Integration of administrative processes: devil is in details, requires expertise and diligence

Moving Forward Working to bring up PACE in Minnesota Implementing statewide All Payer Health Care Home

including CMS Medicare APC demo Care Delivery System Payment Demo RFP will be

issued soon; future steps expected to include FFS and MCO duals

Duals Demonstration Planning Contract with CMS Development of performance metrics, risk adjustment, total

cost of care payment models and provider feedback mechanisms specific to dual eligibles, consistent across managed care and FFS

Pursuing improvements in current SNP and/or new platforms for integrated financing and service delivery

Contact Information

Scott LeitzAssistant Commissioner for Health CareMinnesota Department of Human Servicesscott.leitz@state.mn.us(651) 431-2012

Pam ParkerSpecial Needs PurchasingMinnesota Department of Human Servicespam.parker@state.mn.us(651) 431-2512

SeniorsMSHO (Statewide) 1915 (a)(c)

MSC+ (Statewide)

1915(b)(c )

Enrollment 65+ Voluntary 37,000 (5/11) Mandatory 11,500 (5/11)

Medicare Services

All Medicare services including Part D drugs through Medicare Special Needs Plan (SNP)

Medicare A/B services through Medicare FFS.

Part D drugs through separate Medicare drug plan

Medicaid Basic Care Services

Medicaid state plan services (includes PCA) and remaining drugs through same SNP

Medicaid only plan provides state plan (includes PCA) and remaining drugs

Medicaid Long-Term Care Services

Elderly Waiver (EW) through SNP plus 180 days of nursing home care

EW through same plan plus 180 days of nursing home care

Fee For Service

(46,600 enrollees)

Special NeedsBasicCare (Managed Care)

(6,000 enrollees)

Authority: 1915(a)

Enrollment

Age 18-64

Voluntary, open to both duals and non duals with disabilities in 78 counties (new legislation pending to expand with opt out enrollment process)

Medicare Services

Medicare A/B through FFS

Separate Part D Plan enrollment

All Medicare services including Part D drugs through 4 Medicare Advantage SNPs,

One SNBC MCO does not offer SNP

Medicaid Basic Care Services

Most Medicaid state plan services provided through same SNP plan including remaining drugs except PCA and PDN which remain Fee for Service, provides platform for integration of all behavioral services including MH-TCM.

Medicaid Long-Term Care Services

Includes first 100 days of nursing home care and remaining home health care, Medicaid HCBS waivers and long term care services remain Fee for Service

People with Disabilities