Kasich announces state-federal agreement for 114,000 Medicare-Medicaid enrollees

Governor John R. Kasich’s administration has announced that Ohio has reached agreement with the Centers for Medicare and Medicaid Services (CMS) on a new initiative to better coordinate care for individuals eligible for both Medicare and Medicaid. Ohio is just the third state — after Massachusetts and Washington — to finalize such an agreement with CMS and only the second to use a managed care approach.

“This agreement puts Ohio at the cutting edge of care coordination in the country,” said Gov. Kasich. “Better care coordination across the state means healthier Ohioans, and it will also help in driving down costs in the long run.”

The Office of Medical Assistance (Ohio Medicaid), under the leadership of Director John McCarthy, has worked with federal officials to create an Integrated Care Delivery System (ICDS) to comprehensively manage the full continuum of benefits for Medicare-Medicaid enrollees. Long term services and supports, behavioral-health services and physical-health services are at the center of the finalized pact.

The ICDS will be launched as a three-year demonstration project in seven geographic regions covering 29 Ohio counties and approximately 114,000 individuals. The demonstration will allow Ohio to identify and incentivize innovative techniques for improving care to a highly-acute population.

“We hope to make the most out of this opportunity, and we are eager to continue working with the federal government and Ohio stakeholders in the coming months to implement this new program,” said Director McCarthy

Because Medicaid and Medicare are currently designed and implemented with virtually no connection to each other, the services that are provided to Medicare-Medicaid enrollees are poorly coordinated, leading to diminished quality of care, poor health outcomes for individuals and high costs for the Medicaid system and taxpayers.

In Ohio, approximately 180,000 dually eligible individuals make up only 14 percent of Medicaid enrollment, but these individuals account for 40 percent of total Medicaid spending. The development of the ICDS is a cornerstone of the state’s ongoing efforts to improve access and quality while simultaneously containing the growing costs of Medicaid.

A coalition of stakeholders and advocates worked with state officials in finalizing the terms of the ICDS agreement, including representatives from the aging community.

“In partnering with the state, Ohio’s Area Agencies on Aging will offer our expertise and experience to promote independent living and better health for Ohio’s older adults and people with disabilities,” said Larke Recchie, Executive Director of the Ohio Association of Area Agencies on Aging. “By focusing on the needs of the individual and coordinating care, the ICDS plan has the potential to improve quality of care for lower-income, aging adults while helping to save taxpayer money.”

In August, Ohio selected five health plans, Aetna, Buckeye, CareSource, Molina and United, to help manage and coordinate the care of Medicare-Medicaid enrollees in the ICDS. Ohio Medicaid will launch Ohio's ICDS program in 29 counties on September 1, 2013.

A division of the Ohio Department of Job and Family Services (ODJFS), Ohio Medicaid administers the state’s Medicaid program and provides health coverage to 2.2 million Ohioans with low incomes through a network of 75,000 health-care providers.

Greg Moody, director of the Governor’s Office of Health Transformation, recently announced plans to transform Ohio Medicaid from a division of ODJFS into a cabinet-level state agency effective July 1, 2014.

For more information about Ohio’s initiative to improve care coordination for Medicare-Medicaid enrollees and the ICDS, see http://www.healthtransformation.ohio.gov/CurrentInitiatives/IntegrateMe….