Beginning January 1st, 2014, Center for Medicare and Medicaid Services are unveiling a new benefits initiative that is designed to shift reimbursement dollars for providers thereby affecting services for their senior beneficiaries. The Alignment Initiative’s goal is to integrate the Medicare and Medicaid programs. Partnering with States, health care providers, caregivers and beneficiaries, CMS (Medicare) will work to improve quality, and reduce costs.
Medicare and Medicaid programs differ in funding and scope of service. Medicare primarily covers seniors and certain persons with disabilities with federal funds. Medicaid covers persons with low income utilizing a combination of State and federal funds. They both cover acute care but Medicaid also covers long term services and support. The current outlay looks like this:
Medicare: 46 million seniors @ $424 Billion dollars.
Medicaid: 60 million seniors @ $330 Billion dollars.
Duals: 9 million seniors @ $120.5 Billion dollars.
“Duals” are individuals, eligible for both Medicare and Medicaid. They are only 15% of the Medicaid population but account for almost 40% of the spending. They are 16% of the Medicare population but account for 25% of the spending. This is clearly the population that costs the most money and the Medicare- Medicaid Alignment Initiative is specifically intended to shift most, if not all this population into a Medicaid managed care environment.
Enrollment has begun. Eligible “dual” beneficiaries will be notified of their right to select one of the “demonstration plans”. If a person doesn’t want to be part of the demonstration they need to respond to that notice indicating their choice to stay with Medicare which we highly encourage if your particular situation warrants it. By electing to stay with Medicare, seniors will continue to get services that they are accustomed to including greater access to physicians, specialists and, perhaps, more importantly home health services which help alow you to live comfortably in “your” home .
Beginning Jan. 1, 2014, eligible beneficiaries who didn’t respond will be “passively” enrolled in demonstration plans. They will be notified of the plan and given 60 days to opt out. If they don’t opt out, then they will be covered by the new demonstration plan. There will be a process for disenrollment if you choose. Know your rights. Know your options.
For questions, please call 866-497-6900