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CMS Dual Eligibles Update

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CMS Dual Eligibles Update

July 18, 2011

There is a new wave of attention and interest in the problems that dual eligibles-individuals who qualify for both Medicare and Medicaid-encounter in the current health system. Fifteen percent of Medicaid enrollees are dual eligibles; however, these enrollees represent 40 percent of Medicaid spending. Recognizing potential health care savings and improvement in integrated care for duals, the Affordable Care Act established a new CMS Medicare-Medicaid Coordination Office (MMCO). The new office got underway this spring. Given recent Congressional hearings, State Medicaid Directors Letter, announcements of state demonstration grants and public forums, and Washington briefings, ANCOR is providing updates on this initiative.

ANCOR is serving on a CMS Dual Eligibles (Medicare-Medicaid) Stakeholders Group and receives updates from MMCO Director Melanie Bella.
ANCOR is developing an issue brief regarding the new MMCO and its coordination with the new ACA CMS Center for Medicare and Medicaid Innovation and other resources on individual provider involvement and design of these demonstrations.

Below are several updates regarding person-centered approaches to better coordinate care across primary, acute, behavioral Health and long-term supports and services for dual eligible individuals.

  1. March 1, 2001 Letter to Congress on Initial Update of the MMCO at

2. Fifteen State Demonstrations to Integrate Care for Dual Eligible Individuals. The following states were selected to receive CMS contracts up to $1 million to design new approaches to better coordinate care: California, Colorado, Connecticut, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oklahoma, Oregon, South Carolina, Tennessee, Vermont, Washington, and Wisconsin. The goal is to identify and validate delivery system and payment coordination models that can be tested and replicated in other states. CMS is providing technical assistance to these states. More on demonstrations and state demonstration summaries at

3. ANCOR Member Engagement in 15 States. CMS requires public input in the development of these state integration models. ANCOR received information from CMS in the last two weeks about public forums in July in Vermont, Massachusetts, and Michigan and forwarded notices to alert key ANCOR member leaders in those states and determine provider engagement. We know that Vermont and Massachusetts ANCOR providers are engaged in efforts to design new state approaches to delivering integrated care.

4. July 13th NHeLP and SCAN Briefing. In connection with this briefing this week, SCAN issued the first in a four series issue brief on issues facing duals and recommendations to the MMCO. See first issue brief focusing on consumer protections at

5. CMS State Medicaid Director Letter (SMD 11-008). CMS issued a letter to State Medicaid Directors on July 8th outlining two models for States pursuing integration of primary, acute, behavioral health and long term services and supports for their full benefit Medicare-Medicaid enrollees. Letter at