State Profiles

In this section you can find profiles of each state including the number of dual eligibles who live there and the type of integrated care model the state is considering. Links to state websites on dual eligibles are included if available.

May 07, 2014 

For advocate comments on state proposals, go to Advocate Comments

Implementation Timeline

 

(1.2 million duals)

Capitated-Managed Care Model and/or Managed Fee-for-Service Model

California proposes to contract with risk-based private managed care organizations to provide services in exchange for capitated payments in four counties.  Original target population was all full duals with a 2012 estimated enrollment of 150,000; now proposing 2013 enrollment in up to 10 counties and 750,000 duals.  Proposed opt-out enrollment with six month lock-in.

State website:  www.calduals.org

California Proposal

California MOU  | MOU Fact Sheet

NSCLC’s Summary of the CA MOU

California Three-Way Contract

California Three-Way Contract for Subcontracted Plans

(80,011 duals)

Managed Fee-for-Service Model (AC0)

Colorado proposes to enroll about 30,000 dual eligibles (half its dual population) into Colorado’s Accountable Care Collaborative, a hybrid of a primary care medical home and an ACO. The pilot will be statewide.

State website: www.colorado.gov/cs/Satellite/HCPF/HCPF/1251610502140

Colorado Proposal

Colorado MOU

(114,679 duals)

Managed Fee-for-Service Model (PFFS)

Connecticut is proposing to contract with local Integrated Care Organizations (ICOs) featuring partnerships among multiple provider types facilitated by health information technology and electronic data gathering.  ICOs will be paid a  fee for care management and will partially share in Medicare and Medicaid savings.  Available to all duals 65 and over statewide, to be expanded in third year to include younger duals with disability. Estimated initial enrollment of 13,000 to 20,000, expanding to 120,000 by end of demonstration.

State Website: N/A

Connecticut Proposal 

(245,248 duals)

Capitated-Managed Care Model

Massachusetts is proposing to use Integrated Care Organizations (ICOs), which will either be insurance-based or provider-based health organizations.  Available statewide to full duals aged 21 to 64, opt-out enrollment.  Particular emphasis on meeting behavioral health needs.

State website: www.mass.gov/masshealth/duals

Massachusetts Proposal

Memorandum of Understanding (MOU)

MA Readiness Review Tool

ICO Selection Announcement 

NSCLC’s summary of the MOU

Three-way Contract for Massachusetts Demonstration

Three-way Contract for Massachusetts Summary of Beneficiary Protections

Massachusetts One Care Ombudsman

(100,000 dual eligible individuals)

Capitated-Managed Care Model

Michigan proposes a capitated model using risk-based managed care plans, ACO’s and other capitated entities. Target population is all dual eligibles statewide. Opt out enrollment.

State website: http://www.michigan.gov/mdch/0,4612,7-132-2945_64077-335999–,00.html

Michigan Proposal

Michigan MOU

Michigan Three-Way Contract

(123,575 duals)

Capitated-Managed Care Model

Minnesota  proposes a shared savings model using D-SNPs with waivers from certain current SNP requirements, as well as improvements to current initiatives including implementation of Health Care Homes (HCH) and provider level payment systems such as accountable care organizations (ACOs) and Total Cost of Care payment models. All full dual eligibles statewide with estimated enrollment of 54,300, most of whom will be seniors already enrolled in D-SNPs.

State website: www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_163573

Minnesota Proposal

Minnesota MOU

(691,036 duals)

Capitated-Managed Care Model

New York is proposing a capitated managed care model for New York City building on its Medicaid long term care program.  Approach will be phased with projected eventual statewide enrollment of all duals.

State website: www.health.ny.gov/health_care/medicaid/redesign/managed_ltc_workgroup.htm

New York Proposal

Letter from the Office of Health Insurance Programs to MMCO explaining decision not to pursue demonstration.

New York MOU 

New York Three-Way Contract

Enrollment Timeline

 

(35,707 duals)

Capitated-Managed Care Model

State website: http://www.eohhs.ri.gov/integratedcare/index.php

Rhode Island Proposal 

(134,673 duals)

Capitated-Managed Care Model and/or Managed Fee-for-Service Model

South Carolina is proposing an integrated care model that would use the new Health Home option in ACA.  Enrollment with an opt-out option to HCBS or FFS. The target population is dual eligibles with major diagnostic mental disorders or Alzheimer’s.

State website: http://www2.scdhhs.gov/organizations/south-carolina-dual-eligible-demonstration-project-sc-due

South Carolina Proposal

South Carolina MOU

South Carolina Three-Way Contract

(593,576 duals)

Capitated-Managed Care Model

State website: http://www.hhsc.state.tx.us/medicaid/dep/index.shtml

Texas Proposal

Texas MOU

Texas Three-Way Contract 

(48,000: 21,000 in MFFS, 27,000 capitated)

Capitated and Managed Fee for Service Model

Washington will utilize both a capitated model and a managed fee-for-service demonstration. Under the capitated demonstration, 27,000 dual eligible individuals in King and Snohimish Counties will be eligible to enroll into private managed care plans that will manage Medicare and Medicaid Services.  Voluntary enrollment is scheduled to begin no earlier than July 1, 2014, and passive enrollment will not begin any earlier than September 1, 2014.

Washington was the first state to implement a managed fee-for-service model on July 1, 2013. The managed fee-for-service relies on a Health Home Lead Entity (HHLE) who subcontract with a Health Home Coordinated Care Organization (HCCO) to coordinate the health home services.

State website: http://www.adsa.dshs.wa.gov/duals/

Washington Proposal

Memorandum of Understanding (MFFS)

Memorandum of Understanding (Capitated)

Final Demonstration Agreement (MFFS)

NSCLC’s Summary of the MOU

RFA for Full Integration Capitation

HealthPathWA letter  

 

CMS Dual Eligible Enrollee State Profiles,
http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/StateProfiles.html