HHS calls for greater coordination for dual Medicare-Medicaid enrollees

NEWS IN BRIEF — Posted July 18, 2011

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New demonstration programs announced by the Dept. of Health and Human Services on July 8 will allow states to share savings achieved through better care coordination for people enrolled in both Medicare and Medicaid.

HHS announced that an individual state, the Centers for Medicare & Medicaid Services, and a health plan could enter into a three-way contract that pays the managed care plan a blended rate to provide "comprehensive, coordinated care," and allows any savings to return to states. States also could sign fee-for-service care coordination contracts directly with CMS. HHS proposed a third care coordination model for nursing homes.

HHS Secretary Kathleen Sebelius said states and the federal government spend about $300 billion a year on care for the 9 million people enrolled in both Medicare and Medicaid. HHS expects the demonstration programs to affect up to 2 million of these dual eligibles. Although the population is only about 15% of Medicare and Medicaid enrollees, they account for roughly 30% of health care spending in each program.

A full explanation of the HHS demonstration program is available online (link).

Note: This item originally appeared at

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