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DOH, CMS, and Stakeholders Meet on Future of Medicare-Medicaid Managed Care

Officials from the New York State Department of Health (DOH) and the Centers for Medicare and Medicaid Services (CMS) met with stakeholders in New York City on July 20th to discuss the future of integrated Medicare-Medicaid managed care. With the Fully-Integrated Duals Advantage (FIDA) program slated to end in December 2019, the state is seeking to explore ways to expand and improve integrated care models for individuals dually eligible for Medicare and Medicaid. The meeting included presentations from DOH, CMS, and experts from the Integrated Care Resource Center. Andrew Segal, Director of the DOH Division of Long Term Care, noted that the meeting would be the first in a series to discuss strategies to expand and improve integrated Medicare-Medicaid managed care in New York. Segal described the successes of existing integrated programs such as FIDA, Program of All-Inclusive Care for the Elderly (PACE), and Medicaid Advantage Plus (MAP), including improved coordination, financial alignment, and access to community-based care. He also acknowledged that the array of managed long term care products available in New York State leads to confusion among consumers and providers and opportunities for cost shifting.

Melissa Seeley and Lindsay Barnette from the CMS Medicare-Medicaid Coordination Office described the diverse array of integrated managed care products and the experience of various states that have implemented integrated models. Over 700,000 beneficiaries are enrolled in integrated plans nationwide. Barnette noted that, unlike New York's FIDA program, the majority of Financial Alignment Initiative models in other states include dually-eligible beneficiaries who do not require long term care. CMS has retained an independent evaluator to study the results of these demonstrations. Evaluation reports are expected later this year.

Ann Marie Philip and James Verdier from the Integrated Care Resource Center described the various ways in which states and health plans have structured managed care products for dually-eligible beneficiaries and the challenge of building enrollment in these products. Verdier noted that the single most important strategy for enrollment growth is to connect beneficiaries with a human care manager within two to three weeks. He also described the various strategies that states have implemented to encourage enrollment in integrated products.

Erin Kate Calicchia, the newly-appointed Director of the Bureau of Managed Long Term Care, led the question and answer portion of the meeting. Stakeholders commented on the need for provider buy-in to stimulate enrollment in integrated products, the challenges associated with cultivating provider engagement in these models (especially physician engagement), and the need for more effective engagement strategies targeting consumers and providers. LeadingAge NY noted that, with a physical presence and history of providing services in communities, provider-sponsored plans can play a valuable role in overcoming barriers to enrollment. We also urged the state and CMS to expand the PACE program and the use of alternative care sites in lieu of PACE centers.

The state will be convening work groups over the next several months to develop strategies for integrated managed care. The slides from the July 20th meeting should be available in the next few weeks and will be posted on the LeadingAge NY website when available.

Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8383 ext. 124