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Integrating Care for Dual Eligibles

woman receiving helpThe Idaho Medicaid program was directed by the Idaho Legislature through HB 260 to develop managed care programs that result in an accountable care system with improved health outcomes. Legislation directed Medicaid to focus on high-cost populations, including dual-eligibiles. The Medicaid program is now seeking input of Idaho stakeholders for transitioning care of adults who are dually eligible for Medicare and Medicaid to an integrated, coordinated care system.

The Issue
People who are dually eligible are among the nation’s most chronically ill and costliest patients. They account for close to 50 percent of all Medicaid spending and 25 percent of all Medicare spending. As of June 2011, there were 17,172 people in Idaho who were dually eligible for Medicaid and Medicare. Many in this group have opted to enroll in the Idaho Medicare-Medicaid Coordinated plan for dual eligibles and have average monthly expenditures of $1,500. For dual eligibles not enrolled in the plan, their monthly Medicaid expenditures average $1,800.
The majority of the dual eligible beneficiaries receive fragmented and poorly coordinated care.  In an effort to make sure dual eligible beneficiaries have full access to seamless, high quality health care and to make the system as cost-effective as possible, the federal Medicare-Medicaid Coordination Office was established pursuant to Section 2602 of the Affordable Care Act.

2014 Updates

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Medicaid was participating in the Duals Demonstration to Integrate Care for Dual Eligibles in Idaho for 2014. However, Medicaid received communication from the Duals office in September 2013, that the prospect of a Demonstration with only one participating health plan was no longer a viable option. Although six Health Plans expressed initial interest in the Demonstration for 2015, Idaho Medicaid has decided to pursue expansion of the covered benefits in the MMCP in 2014 and beyond and will not be participating in the Demonstration. 

Idaho Medicaid has a Medicare-Medicaid Coordinated Plan (MMCP) for dual-eligible individuals with more than 650 participants enrolled in one participating Medicare Advantage plan. This model is a voluntary program that permits a dual-eligible beneficiary to enroll in a single managed care organization (MCO) that receives capitation payments to deliver both Medicaid and Medicare services to the individual.

With Idaho legislative direction in House Bill 260, Medicaid continues to work on the development of a managed care plan for dual eligibles that will result in an accountable system of care with improved health outcomes.  Medicaid remains interested in working with Health Plans and stakeholders to gather ideas on how to integrate primary, acute, behavioral health and long term services and supports.  Please send comments to

You are invited to participate in a Duals-Medicare-Medicaid Coordinated Plan (MMCP) Update

WHAT: WebEx Presentation:  Duals – MMCP Update

WHEN: Friday, May 2, 2014 10:30am, Mountain Daylight Time (Denver, GMT-06:00)

NOTE: Registration is required and space is limited. Please register no later than 9:00 am (MDT) at the link below:

Please note: Registration must be completed at least one hour prior to the commencement of presentation for you to participate.

Once the host approves your request, you will receive a confirmation email with instructions for joining the meeting.

Information for Friday, May 2, 2014:
Event Number: 660 190 700
Event Password: Duals
Event Address for Attendees:

For Audio/Teleconference dial:

Participant Code: 8674539#


Thank you.