FSSA: Integrating Medicaid & Medicare

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Progam Initiative for Indiana Dually-Eligible Members

“Duals” are members who are eligible for both Medicare and Medicaid benefits. On average, the duals population is lower income and in poorer health than members who are eligible only for one of these programs. As of August 2011, Indiana had over 125,000 fully-eligible dual members being served under traditional Fee-For-Service Medicaid. This population is not currently served within the Hoosier Healthwise and Care Select programs. Indiana is interested in developing a program specifically designed to meet the needs of the dual population. The State is convening meetings with outside organizations and other State agencies to gather valuable information in the program design process. A Duals Advisory Council has been established that meets on a quarterly basis. Additionally, the Office of Medicaid Policy and Planning (OMPP) is dedicated to receiving input from dually-eligible beneficiaries through focus groups. Links to stakeholder presentations and Advisory Council meeting information are provided for reference.

Resources:

Documents:
- Stakeholder Meeting Presentation – December 13, 2011
- Stakeholder Meeting Presentation – April 20, 2012
- Advisory Council Meeting Agenda and Notes – April 20, 2012
- Stakeholder Meeting - July 13, 2012
- Stakeholder Meeting Agenda and Minutes - November 19, 2012
Links:
- CMS Medicare-Medicaid Coordination Website
Public Meetings:
- Advisory Council Meeting: July 13, 2012, 1:00pm - 2:30pm; Indiana Government Center South, Conference Room C

FAQs:

Q: What is the implementation time frame for the new duals program?

A: The time frame to begin implementation of the new initiative is July-October, 2013.

Q: Will the current nursing home population be included in the duals program?

A: The State continues to research all options before making a final determination on inclusion of the nursing home population. However, it is not anticipated individuals enrolled in a long term care stay at the time of open enrollment for the duals program, would be eligible for the program.

Q: What is the State’s current thinking about program design?

A: The State continues to research all options before making a final determination on program design. However, a risk-based managed care design, that would be inclusive of long term care services, is anticipated.

Q: Will there be some form of case coordination/management?

A: Yes, a robust care coordination or case management component will be a fundamental part of the program. The State continues to gather input from various agencies, external stakeholders, and members to understand better what the care coordination component will entail.

Q: Will this be a statewide initiative?

A: The State continues to gather data and consult with stakeholders and members to make a final decision whether to implement the program state-wide, to pilot the program in select areas, and/or to phase-in the program regionally over time.

Q: Will this new program impact the population currently served in the Home and Community Based Services (HCBS) waiver program?

A: At this time, it is not anticipated this program will impact individuals currently being served under HCBS waivers.

Q: Has the State considered the impact of the Affordable Care Act (ACA) on the duals program?

A: The State is evaluating the impact ACA may have on the duals program and will work to ensure that ACA requirements are considered in the program’s design.

Q: Will there be an option for dually-eligible members to opt-out of the program?

A: Yes, members will have the opportunity to opt-out of the program.