The federal Centers for Medicare and Medicaid Services (CMS) announced Thursday that they would offer up to $12 million in funding for states to develop ombudsmen programs for their efforts to better coordinate care between Medicare and Medicaid.
The demonstration projects were created by the Affordable Care Act (ACA), and six states have been approved for them so far and 20 others have applied. The projects aim to improve the experience of the roughly 9 million elderly and disabled Americans who qualify for both programs, known as dual-eligibles. As Governing has reported, because the programs pay differently and cover different services, care is often fragmented.
The earliest states are formally launching thier demonstrations in summer 2013.
The $12 million, which will be spread over three years, will help states create oversight entities to monitor the demonstrations' progress and handle any issues that patients have. A patient's care will be overseen by one health plan for most of the demonstrations, so the ombudsmen will serve as an independent overseer and adviser. If patients have problems with their new care, they will be able to go to the ombudsmen to voice them.
States have also committed to meeting cost-savings goals under their agreements with CMS -- usually 1 percent in the first year and 4 percent by the third -- and the ombudsmen will make recommendations about how to meet those goals. Dual-eligibles account for 15 percent of the Medicaid population but 40 percent of its spending, so cost-savings are a significant element of the demonostrations.
“These demonstrations are about ensuring Medicare-Medicaid enrollees have access to more coordinated care, making the health care system better for consumers and more efficient,” CMS Administrator Marilyn Tavenner said in a statement. “This funding will make these demonstrations stronger by sharpening their focus on the beneficiary experience.”
The first round of funding applications will be due July 30. CMS expects to accept applications again in October and January.