Briefs & Reports

Integrated Care for Dual Eligibles

In previous editions of The Michigan Update we have written about Michigan’s plan to implement an integrated delivery system of health care for adults dually eligible for Medicare and Medicaid (duals). The demonstration will last for three years and in four regions of the state. The entire Upper Peninsula is one region; eight counties in the southwest corner of the state are another region; and Wayne and Macomb Counties are two single-county regions.

Enrollment in the demonstration began in the Upper Peninsula and southwest regions in February with first enrollments effective on March 1, 2015. There is one Integrated Care Organization (ICO) serving the Upper Peninsula, the Upper Peninsula Health Plan, and two ICOs serving the eight southwest counties: Aetna Better Health (CoventryCares) of Michigan and Meridian Health Plan of Michigan. As of April 1, 2015, the most recent data available, there was a combined total of 134 enrollees in these plans. The Upper Peninsula Health Plan had 32 enrollees; Aetna Better Health had 21 enrollees; and Meridian Health Plan had 81 enrollees.

Enrollment in the other two regions – Wayne and Macomb Counties – began in early April with first enrollments effective on May 1, 2015. There are five ICO choices in these two regions: Aetna Better Health of Michigan, AmeriHealth Michigan (partnered with Blue Cross Blue Shield of Michigan), Fidelis SecureCare of Michigan, HAP Midwest Health Plan, and Molina Healthcare of Michigan.

Both phases began with voluntary enrollments and will be followed by a passive enrollment process; duals passively enrolled will be able to opt out of the demonstration if they wish. The number of duals voluntarily enrolling in the demonstration thus far is low but the Michigan Department of Health and Human Services (MDHHS) expects that the passive enrollment process will raise total participation significantly.

MDHHS has received approval from the Centers for Medicare and Medicaid Services to reclassify duals residing in these regions as “excluded” rather than “voluntary”, which means they will be disenrolled from Medicaid HMOs not serving as ICOs in the demonstration and will be given the option to enroll in an ICO or receive their Medicaid benefits on a fee-for-service basis.

For more information, contact Esther Reagan, Senior Consultant, at (517) 482-9236.