Serving Individuals Eligible for both Medicare and Medicaid: Oregon's Approach
In addition to services for individuals eligible for Medicaid alone, Oregon’s Coordinated Care Organizations (CCOs) must offer a Medicare option to their Medicaid members who are also enrolled in Medicare no later than January 2014. This means dually eligible members of a CCO could enroll in a Medicare plan that is owned or otherwise affiliated with the CCO. People who enroll in aligned plans find that their providers communicate and coordinate their care better. They also find that working with plans and providers is often simpler since the plans cover the same provider networks.
In May, Oregon submitted a proposal to the Centers for Medicare & Medicaid Services (CMS) to participate in a CMS Financial Alignment Demonstration, which would have included new three-way contracts among the state, CMS and CCOs for blended Medicare and Medicaid payments. Although the demonstration would offer opportunities to align and integrate Medicare and Medicaid benefits and financing that could result in better health and quality of care for individuals who are dually eligible, OHA has determined that the demonstration is not likely to be financially viable for Oregon’s CCOs and their affiliated Medicare Advantage plans.
As a result, Oregon decided not to pursue a Medicare/Medicaid Financial Alignment demonstration as it is currently constructed. OHA will work with CMS and stakeholders to build on the work developing the proposal to continue to improve alignments between Medicare and Medicaid for Oregonians enrolled in both programs.
Timeline: Over this winter and next spring (2012/2013), OHA will work with CMS, Oregon CCOs and affiliated Medicare Advantage plans, and stakeholders to assess the opportunity for a modified demonstration with CMS that would better align the Medicare and Medicaid programs and result in improved outcomes and better health care experiences for individuals who are dually eligible.
October 30, 2012: Oregon will not pursue a CMS Medicare/Medicaid Financial Alignment Demonstration. See the Memo to CCOs and Stakeholders.
April 19, 2012: CCOs must offer Medicare option by January 2014, either through the Medicare/Medicaid Demonstration or through a Medicare Advantage plan. Appendix D to the RFA (addendum #10)
Background on Medicare/Medicaid Alignment Work within OHA
In April 2011, Oregon was one of 15 states awarded a CMS Design Contract to develop a proposal to integrate Medicare and Medicaid for individuals eligible for both programs. After an extensive stakeholder process in summer through winter 2011, Oregon developed a proposal for integrating Medicare and Medicaid via Coordinated Care Organizations through participation in the CMS financial alignment demonstration.
The Oregon Health Authority submitted the final proposal to the CMS for consideration of approval on May 11, 2012. The draft proposal was posted for public comment and CMS posted the final proposal for a national, 30-day public comment period. See links below for the proposals and comments we received. OHA thanks all who took time to contribute comments.
OHA Resources Related to Oregon’s Original Proposal (Note: Oregon is no longer pursuing a Financial Alignment Demonstration)