State Medicaid Integration Tracker©

State

Medicaid Managed LTSS and Other Updates

Health Homes

The State’s Health Homes State Plan Amendment is under review by CMS.  Target population includes individuals with two chronic conditions, one and at risk for another or SMI: all conditions in statute except BMI over 25; other chronic conditions include transplants, CVD, cancer, COPD, sickle cell anemia, HIV. (Source: Integrated Care Resource Center)

Currently Operating Medicaid Managed LTSS Program

Under Medicaid Section 1115 waiver authority, Arizona Health Care Cost Containment System provides health care services through a prepaid, capitated managed care delivery model that operates statewide for both Medicaid State plan groups as well as demonstration expansion groups. The goal of the demonstration is to provide organized and coordinated health care for both acute and long-term care that includes pre-established provider networks and payment arrangements, administrative and clinical systems for utilization review, quality improvement, patient and provider services, and management of health services. Beneficiaries receiving long-term care services receive additional benefits that would not otherwise be provided through the Medicaid State plan. (Source: Medicaid.gov)
State Program Website
Fact Sheet
Current Approval Document

Rate reductions were instituted for the 2011-2012 contract year for virtually all institutional and non-institutional services covered under AHCCCS.  The State released (8/10/2012) final rule of the AHCCCS to maintain reimbursement reductions for inpatient and outpatient hospital services covered through the AHCCCS program that were instituted last contract year (October 1, 2011 through September 30, 2012) and to eliminate adjustments to those rates based on inflation. (Source: BNA Register, August 17, 2012)

The State recently submitted (11/9/2012) amendment to its 1115 Waiver to extend the State’s authority (1) to provide Medicaid coverage to adults without dependent children with incomes between 0% and 100% of the Federal Poverty Level (“Childless Adults”) for the entire period of its Demonstration, and (2) to obtain the enhanced federal medical assistance percentage (FMAP) for Childless Adults beginning January 1, 2014. No changes to the benefit package or to the current cost sharing requirements are being proposed through this amendment.
Application for amendment (11/9/2012)

State Demonstration to Integrate Care for Dual Eligible Individuals

(Withdrawn)

On April 10, AHCCCS Director Thomas Betlach submitted a letter withdrawing the State’s proposal to participate in the CMS Capitated Financial Alignment Demonstration for members that have AHCCCS and Medicare. Arizona will continue to work with the CMS Medicare-Medicaid Coordination Office to improve the system for dual eligible members through the current managed care model by leveraging D-SNPs. (Source: State Website)
Arizona Capitated Financial Alignment Demonstration Withdrawal Letter (4/10/2013)

Section 1915(k) Community First Choice (CFC) Option

Arizona submitted application for Community First Choice Option to CMS, targeting Fall 2012 for implementation.
Arizona Long Term Care System (ALTCS) Update (5/16/2012)

Health Homes

The Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS) and the Arizona Health Care Cost Containment System (AHCCCS) were awarded (3/29/2011) a planning grant to explore the feasibility of a Regional Behavioral Health Authority (RBHA) model with expanded responsibility for Title XIX eligible adults determined to have a Serious Mental Illness (SMI). This RBHA model is referred as "Recovery through Whole Health". This RBHA is funded for and fully responsible for coordinated and integrated behavioral healthcare and physical healthcare for Title XIX eligible adults with SMI through the use of Health Home Services. It is based on the goals, principles and concepts contained in the Health Home provisions in Section 2703 of the Affordable Care Act. (Source: State Website)
State Resource

Arizona Health Care Cost Containment System (AHCCCS) Director Testifies before the U.S. Senate on Duals Demonstration

The state Medicaid Director Tom Betlach testified before the U.S. Senate Special Committee on Aging regarding the success of Medicaid managed care for dual eligible members in Arizona.
Overview

Arkansas

Health Homes

CMS approved planning request. (Source: Integrated Care Resource Center)

Balancing Incentive Program

The Centers for Medicare & Medicaid Services (CMS) announced (3/15/2013) that Arkansas will receive an estimated $ 61.2 million in enhanced Medicaid funds (2% enhanced FMAP rate).  (Source: Balancing Incentive Program Award Letter)
BIP Application (11/27/2012)

BIP Award Letter (3/15/2013)

California

Currently Operating Medicaid Managed LTSS Program

Under Medicaid Section 1915(a) authority, SCAN Connections at Home provides long-term services and supports (LTSS) to Medicare-Medicaid enrollees of age 65 and older at capitated rate.  Services include nursing facility and HCBS waiver-like services, including homemaker, home delivered meals, personal care, transportation escort, custodial care, in-home respite, and adult day. The program operates in limited geographic area and enrollment is voluntary.  (Source: CMS and Truven Health Analytics, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012)

SCAN Connections at Home

State Demonstration to Integrate Care for Dual Eligible Individuals

Coordinated Care Initiative (CCI): The state submitted a revised demonstration proposal to CMS on May 31, 2012.  On June 27, 2012, the governor approved a bill (SB 1008) to revise the existing law to require the Department of Health Care Services to establish demonstration sites in up to eight counties not sooner than March 1, 2013.  (Source: Calduals.org, July 3, 2012)   According to the demonstration proposal, target population includes all full benefit Medicare-Medicaid enrollees who are age 21 or over in eight counties with specified exceptions.  Full benefit dual eligible beneficiaries are those Medicare beneficiaries with Parts A, B, and D coverage and full Medi-Cal coverage. Medi-Cal covers Medicare premiums, co-insurance, copayments, and deductibles, as well as services that Medicare does not cover (primarily long-term services and supports). Beneficiaries with developmental disabilities who are receiving services from the Department of Developmental Services and regional centers are carved out from the demonstration, while some people with developmental disabilities receiving services through the State's in-home supportive services (IHSS) and community-based adult services (CBAS) will be included in the demonstration. Those enrolled in 1915(c) HCBS waiver programs are also excluded from the demonstration. Covered benefits include Medicare (Parts A, B and D) and Medicaid covered services. The demonstration will use a capitated payment model.  (Source: Demonstration Proposal; NASDDDS Managed Care Tracking Report)  State officials proposed (05/25/2012) a change in the implementation date, from March 2013 to June 2013. (Source: www.californiahealthline.org, May 30, 2012)   

Demonstration Proposal
State Website on Coordinated Care Initiative
Timeline
Coordinated Care Initiative Fact Sheets on CalDuals.org

CMS announced on March 27, 2013 that California would be the fifth state to enter into a Memorandum of Understanding (MOU) to integrate care for dual eligible beneficiaries as a component of California’s Coordinate Care Initiative (CCI).  According to the State’s website, the project will be called the Cal MediConnect from now on. Through Cal MediConnect, eligible beneficiaries will have the opportunity to combine all their Medicare and Medi-Cal benefits into one health plan — and receive more coordinated and accountable care. Enrollment is expected to begin no sooner than October 1, 2013. (Source: CalDuals, accessed 3/28/2013)

Duals Demonstration

State officials proposed (05/25/2012) a three-month delay in the start date for the duals demonstration project, also known as the Coordinated Care Initiative (CCI), which was originally slated to begin in March 2013. The state now plans to start the program in June 2013. (Source: www.californiahealthline.org, May 30, 2012)  The state submitted (05/31/2012) a revised demonstration proposal to the Centers for Medicare and Medicaid Services (CMS).  (Source: Calduals.org, May 31, 2012)  On June 27, 2012, the governor approved a bill (SB 1008) to revise the existing law, which permitted implementation in 2013 in four counties – Los Angeles, Orange, San Diego, and San Mateo. The new legislation requires the Department of Health Care Services to establish demonstration sites in up to eight counties not sooner than March 1, 2013.  The four additional counties are San Bernardino, Riverside, Santa Clara, and Alameda. (Source: Calduals.org, July 3, 2012)
State Website on Coordinated Care Initiative

Section 1915(k) Community First Choice (CFC) Option

California is the first state to receive approval from CMS (9/4/2012) to enact the Community First Choice Option, which will provide the state an estimated $573 million in additional federal funds during the first two years of implementation. Community First Choice will enhance Medi-Cal’s ability to provide community-based personal attendant services and support to seniors and persons with disabilities to certain enrollees who otherwise would need institutional care. California immediately will begin claiming the Community First Choice federal funding, which is retroactive for most In-Home Supportive Services (IHSS) program services provided since December 1, 2011.

Press Release (9/4/2012)
State Website
Letter to County Welfare Directors and In-Home Supportive Services Program Managers

Section 1915(i) State Plan Amendment

California Department of Health Care Services (DHCS) submitted two 1915(i) state plan amendments in 2009. The first one proposes to target developmentally disabled individuals with a need for habilitation services.  This SPA will extend Medi-Cal coverage for existing specialized health and other HCBS provided to Medi-Cal eligible persons with developmental disabilities.  Medi-Cal eligible persons with developmental disabilities who do not meet the criteria for institutional long-term care services will be covered under this State Plan option.  Services to be provided would include community living arrangement services, respite care, and day services. The state anticipates serving 42,000 in the first year.  The second one proposes to target infants and toddlers with developmental delays and would provide a 1-day session with families to prepare the children for school or other appropriate facilities, which is currently funded with state-only funds. California anticipates serving 3,800 in the first year. (Source: U.S. Government Accountability Office.  States' Plans to Pursue New and Revised Options for Home- and Community-Based Services. June 2012)

Health Homes

CMS approved planning request. (Source: Integrated Care Resource Center)

Colorado

Connecticut

State Demonstration to Integrate Care for Dual Eligible Individuals

The demonstration will serve dual eligible (MMEs) age 18 to 64, and age 65 and older.  The populations served will include individuals with Serious mental illness (SMI), and individuals with Intellectual and Developmental Disabilities, with increased coordination focused on acute health care. (Source: NASDDDS Managed Care Tracking Report) Covered benefits include Medicaid State Plan services (including 1915(i)), Medicaid waiver services, Medicare Parts A, B and D, and adjunct services and supports, such as Intensive Care Management, chronic disease self-management education, nutrition counseling, falls prevention, medication management services, and potentially also, peer support and recovery assistance. The demonstration will utilize a managed fee-for-service payment model. Participation of MMEs in the Administrative Services Organization (ASO) model will begin statewide effective January 1, 2013.  Participation of MMEs in Health Neighborhoods (HN) model will be launched on a pilot basis in limited service areas starting April 1, 2013.  The Department then plans to use the knowledge gained in this pilot period to expand the initiative to serve additional MMEs, and also potentially to expand the model to serve single-eligible Medicaid individuals (MEs) and convert risk-adjusted advanced payments to HNs (APM II) to a Health Home coverage option. (Source: Demonstration Proposal)

Balancing Incentive Program

The Centers for Medicare & Medicaid Services (CMS) announced (12/7/2012) that Connecticut will receive an estimated $72.8 million in enhanced Medicaid funds (2% enhancement of the State’s FMAP rate). (Source: CMS Balancing Incentive Program website)  
CMS Award Announcement (12/7/2012)
BIP Application (10/31/2012)

Section 1915(i) State Plan Amendment

Connecticut has submitted application for Section 1915(i) State Plan Option. (Source: NASUAD)  The target populations are elderly and disabled individuals. The services covered by the option are adult day health, care management, homemaker, personal care assistant, respite, assisted living, assistive technology, chore services, companion, environmental accessibility adaptations, home delivered meals, mental health counseling, personal emergency response systems, and transportation. Effective date is February 1, 2012.
State Plan Amendment

Connecticut restructures the state’s relationships with Medicaid managed care plans

Starting January 1, 2012, Connecticut began directly reimbursing health care providers, while a non-profit organization, Community Health Network of Connecticut, Inc., provides care coordination and customer service for all of the state’s Medicaid and Children’s Health Insurance Program beneficiaries, plus members of a state-funded health programs for low-income adults — about 600,000 people in all.  All services will be coordinated by the Department of Social Services’ single, statewide administrative services organization, or ASO. (Source: Stateline; Community Health Network of Connecticut, Inc.)
Press Release
Request for Proposals (April 2011)

Delaware

Currently Operating Medicaid Managed LTSS Program & State Initiatives to Integrate Care for Dual Eligible Individuals

Amendment to Diamond State Health Plan (DSHP) Section 1115 Medicaid managed care demonstration waiver (approved 3/22/2012) added Diamond State Health Plan Plus (DSHP Plus) in order to integrate Long Term Care Medicaid and other full-benefit dual eligible into the DSHP. DSHP Plus began on April 1, 2012. 

Services provided in capitated rate include primary, acute, and behavioral services, and LTSS.  Prescription drugs are carved out of both DSHP and DSHP Plus.  Target population includes older persons, persons with physical disabilities, persons with HIV/AIDS, persons using Money Follows the Person services, workers with disabilities using Buy-in, Medicare-Medicaid enrollees, and all SSI-eligible children and adults except persons in ICF/MRs and persons in DD/MR 1915(c) waiver. 

The amendment also consolidates Elderly/Disabled, Acquired Brain Injury, and Assisted Living 1915(i) waivers into one Elderly and Disabled waiver program. Elderly and Disabled waiver program and AIDS/HIV waiver will be incorporated into the long-term care managed care program. (Source: Medicaid.gov;  DSHP Fact Sheet)
Waiver Amendment Request Letter to CMS
Current Approval Document
Diamond State Health Plan website

Final rule of the Department of Health and Social Services, Division of Medicaid and Medical Assistance, amends and adopts regulations regarding the Diamond State Health Plan (DSHP) Section 1115 Medicaid managed care demonstration waiver. The rule expands the DSHP to include Long-Term Care Medicaid and other full-benefit dual eligible beneficiaries under the name Diamond State Health Plan Plus. The rule is effective June 10, 2012.  For more information, please click here. (Source: BNA Register, 6/12/2012)

Section 1915(i) State Plan Amendment

According to a DC official, the District is looking to develop and implement the 1915(i) state plan option in the Affordable Care Act for its Day Treatment program, and is currently engaged in conversations with CMS technical assistance contractor to determine how the District can best use the 1915(i) option in its effort to bring Day Treatment service delivery into compliance.  Target population will include older adults, adults with physical disabilities adults with mental illness, and adults with intellectual and developmental disabilities. (Source: NASUAD)

Health Homes

CMS approved planning request. (Source: Integrated Care Resource Center)

Florida

Currently Operating Medicaid Managed LTSS Program

Florida Long-term Care Community Diversion Program operating under 1915(a) and 1915(c) Medicaid authorities serves Medicare-Medicaid dual eligible of age 65 and older in 46 of 67 counties in the State.  The State is currently processing applications for the remaining counties.  Enrollment is voluntary with opt in.  (Source: CMS and Truven Health Analytics, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012)
State Website on Long-term Care Community Diversion Program
Approved Waiver

Projected Medicaid Managed LTSS Program  & State Initiatives to Integrate Care for Dual Eligible Individuals

The Florida Agency for Health Care Administration (AHCA) recently (2/1/2013) received approval of its application for a 1915(b)(c) combination waiver from CMS to implement the long-term care component of the State Medicaid Managed Care (SMMC) Program. These simultaneous (b) & (c) waivers are effective beginning July 1, 2013, through June 30, 2016.The Agency had submitted (8/1/2011)  initial 1915(b) waiver application and a concurrent initial 1915(c) waiver application to the CMS to implement the Florida Long Term Care Managed Care program as mandated by the 2011 Florida Legislature (House Bill 7107).  The legislature required the agency to create a statewide long-term care managed care program for Medicaid recipients who are (a) 65 years of age or older, or age 18 or older and eligible for Medicaid by reason of a disability; and (b) determined to require nursing facility level of care.  The specific authorities requested in the 1915(b) and (c) waiver applications will allow the State to require eligible Medicaid recipients to receive their nursing facility, hospice, and home and community based (HCB) services through long term care (LTC) plans selected by the State through a competitive procurement process. With the implementation of Florida Long Term Care Managed Care, five of Florida’s current HCBS waivers will be phased out, and eligible recipients (older persons or adults with physical disability who meet nursing facility level of care) will receive HCBS through a the new 1915(c) Florida Long Term Care Managed Care Program waiver that will operate concurrently with the 1915(b) Florida Long Term Care Managed Care Program.  The Agency has begun implementation, and must complete statewide implementation by October 1, 2013.  Mandatory enrollment populations include Medicare-Medicaid dual eligible (fee-for-service). (Source: Florida Long-term Care Managed Care Program Website; CMS and Truven Health Analytics, July 2012)

Approval letter (2/1/2013)
Section 1915(b) waiver application
Section 1915(c) waiver application

Florida AHCA Long-term Care (LTC) Managed Care Invitation to Negotiate (ITN) Attachment D (12/28/12)
Florida Long-Term Care Managed Care Program Overview (8/1/2011)
Technical Advisory Workgroup Final Report (8/21/2012)

Florida Medicaid Reform—Section 1115 Demonstration Waiver (Approved 12/15/2011)

Under Florida Medicaid Reform waiver, most Medicaid beneficiaries in five counties are required to enroll in a managed care plan (either a capitated health plan or a fee-for-service Provider Service Network plan) as a condition of eligibility for Medicaid. Participation is mandatory for TANF-related populations.  Voluntary participants include individuals residing in an institution such as a nursing home, sub-acute inpatient psychiatric facility for individuals under the age of 21, or an ICF-DD; dual eligible individuals; and individuals with developmental disabilities. (Source: Medicaid.gov, Fact Sheet)
Fact Sheet
Current Approval Document
Medicaid Reform waiver website
Letter to CMS - Medicaid Managed Care Policies (10/13/2012)

Section 1915(i) State Plan Amendment

The State implements the optional 1915(i) State plan Home and Community-Based Services (HCBS) benefit for delinquent youth with serious emotional disturbances and their families.  The operating agency is the Department of Juvenile Justice.

Georgia

Balancing Incentive Program Grant Award

The Centers for Medicare & Medicaid Services (CMS) announced (6/13/2012) that Georgia will receive estimated $64.4 million of enhanced Medicaid funds (2% enhanced rate).  Approved work plan is available here. (Source: CMS Balancing Incentive Program website)
CMS Award Announcement (6/13/2012)
Balancing Incentive Program Grant Application (Submitted to CMS 3/3/2012)

Medicaid & CHIP Redesign Initiative

The state-commissioned report by a consultant recommended moving all people in Medicaid into managed care.  That would include those in nursing homes and people with disabilities, who are currently in a traditional fee-for-service system.  The Department of Community Health, which runs Medicaid and PeachCare, expressed interest in protecting UPL in a manner similar to Texas and California, should the program be changed to "full-risk" managed care.  Under UPL, the state is able to get a higher reimbursement rate (at the Medicare level) for delivering Medicaid services.  Texas received a five-year waiver from the CMS to move almost 1 million additional Medicaid enrollees into managed care plans, while still keeping federal matching funds for hospitals.  The waiver requires hospitals to increase primary care access and health quality.  (Source: Kaiser Daily Health Policy Report, May 31, 2012)  The full implementation of the Georgia Medicaid changes was set to start in January 2014. (Source: GeorgiaHealthNews.com, March 29, 2012).  The state’s Medicaid agency recently announced (6/4/2012) an updated timeline for its decision on how the health program will be restructured.  Officials plan to award the vendor contract(s) in early 2013, with a projected implementation roll-out starting in the first half of 2014. (Source: Georgia Department of Community Health)  For the updated timeline, please visit State Medicaid Redesign Initiative website.

Currently Operating Medicaid Managed LTSS Program

The State’s QUEST Expanded (QEx) program is a statewide section 1115 demonstration (approved 6/14/2012).  The Demonstration enables the State to operate QUEST, which provides Medicaid coverage for medical, dental, and behavioral health services through competitive managed care delivery systems.  The four programs included in QEx (QUEST; QUEST-Net; QUEST-ACE; QExA) use capitated managed care as a delivery system unless otherwise noted.  The QUEST Expanded Access (QExA) component provide acute and primary care using managed care, as well as institutional and home and community-based long-term-care services through comprehensive and specialized managed care plans to individuals eligible as ABD under the Medicaid State Plan. Enrollment is mandatory regardless of need for LTSS.  (Source: Medicaid.gov; CMS and Truven Health Analytics, July 2012)
Approval Document (6/14/2012)
Fact Sheet
Additional information

Department of Human Services (DHS) requested (05/29/2012) CMS for a three-year extension of the QUEST Expanded Section 1115 demonstration program, which otherwise would expire on June 30, 2013.  DHS will submit a separate proposal, with a separate notice and opportunity for comment, to amend the Demonstration to reflect new requirements in the Affordable Care Act that take effect January 1, 2014. (Source: Hawaii State Med-QUEST Division)

Governor signed a bill related to QUEST Expanded Section 1115 Demonstration Waiver

Governor Neil Abercrombie signed (7/3/2012) H.B. 2275 into law.  The legislation establishes a hospital sustainability fee and the hospital sustainability program special fund to receive Medicaid matching funds under the QUEST Expanded Medicaid Section 1115 Demonstration Waiver.  It requires the Department of Human Services (DHS) to charge and collect a provider fee on health care items or services provided by private hospitals.  The law will be effective on July 1, 2012. 

Press Release (7/6/2012)

State Demonstration to Integrate Care for Dual Eligible Individuals

(Withdrawn)

According to a State Official, the State has decided not to pursue the demonstration at least in calendar year 2014. (Source: NASUAD) Hawaii’s proposed QExA Integrated with Medicare (QExA-IM) Program was based upon leveraging the existing  QExA program model to deliver integrated care to dual eligibles (MMEs). The target population would have included the eligible MME portion of the existing QExA population, including children and adults with disabilities and the elderly, but excluding individuals enrolled in the DD/ID 1915(c) home & community-based services (HCBS) waiver program.  Adults with serious mental illness (SMI) would also have been  included in the demonstration as originally proposed to CMS, but specialized behavioral health services would have  remained carved out. Individuals receiving HCBS under the State’s approved 1115 waiver would also have been included.  Under Hawaii’s original proposal, covered benefits would have included  Medicaid State Plan services; Medicaid waiver services; Medicare Parts A,B & D;  behavioral health; and “community-based services”. Hawaii had proposed to implement the  demonstration on a statewide basis utilizing passive enrollment with an opt-out. QExA health plans would receive a capitation payment for the combined Medicare and Medicaid benefit package for members enrolled in the QExA-IM. QExA health plans would also have received different capitation rates for those individuals enrolled and those not enrolled in the QExA-IM demonstration. Hawaii had originally proposed a January 2014 implementation date, but the State has now decided to withdraw that proposal and reevaluate its options.   (Source: Demonstration Proposal)

State Demonstration to Integrate Care for Dual Eligible Individuals

Idaho Demonstration to Integrate Care for Dual Eligibles will replace the existing Medicare-Medicaid Coordinated Plan, which will continue to cover and coordinate Medicare and many Medicaid services through the end of 2013.  Starting on January 1, 2014, the demonstration will enroll all full dual eligible ages 18 and older, including older persons, persons with physical disabilities, persons with developmental/intellectual disabilities, and persons with severe mental illness.  The new program will utilize mandatory enrollment into health plans under concurrent §1915(b)/§1915(c) Social Security Act authority for Medicaid plan benefits, and passive enrollment with an opt-out provision for Medicare benefits. (Source: Demonstration Proposal)
State Website on Integrating Care for Dual Eligibles

Summary of the Idaho Initiative to Integrate Care for Dual Eligibles (10/10/2012)

Health Homes

According to the State’s website on Health Homes, CMS approved the State’s Health Homes State Plan Amendment, and implementation began on January 1, 2013. According to the State’s Demonstration Proposal to Integrate Care for Dual Eligibles, the State is working to create a Medicaid State plan option to offer health homes for individuals with the following conditions: 1) A serious, persistent mental illness, or; 2) Diabetes and an additional condition, or; 3) Asthma and an additional condition.  The new coordinated plans for dual eligibles will need to contract with the health homes to ensure that those benefits will be made available to all qualifying dual eligible individuals, as they will become required Medicaid State plan benefits.  The health homes model will provide care for an individual’s physical condition, and it will also provide links to long-term community care services and supports, social services, and family services. The health homes will receive Fee for Service payments from the health plan for services rendered. The health home will also receive per member per month payment for the coordinating and managing the Medicaid services of individuals who qualify for health homes. (Source: Demonstration Proposal to Integrate Care for Dual Eligibles)

Approved Health Home State Plan Amendment (11/21/2012)
State Website on Health Homes

Section 1915(i) State Plan Amendment

According to a State official, Section 1915 (i) State Plan Amendment is under development, and target population includes non-institutional participants with developmental disabilities and aged and disabled participants who meet eligibility requirements. (Source: NASUAD)

Currently Operating Medicaid Managed LTSS Programs

The Medicaid reform law adopted by the Illinois General Assembly in 2011, P.A. 96-1501, mandates that 50 percent of all Illinois Medicaid recipients be in coordinated care by January 1, 2015.  Currently, Illinois Medicaid has two managed care programs that provide long term services and supports.

The Illinois Department of Healthcare and Family Services (HFS) implemented the state’s first integrated health care program, known as Integrated Care Program (ICP) on May 1, 2011. The program is operated by two MCOs.  Eligible populations are non-Medicare eligible older adults and adults with disabilities receiving Medicaid including all Home and Community Based Waiver enrollees. The program is mandatory and operates in the pilot areas of suburban Cook, DuPage, Kane, Kankakee, Lake and Will Counties.  Service package includes Phase I (primary, acute, behavioral health substance abuse services, and pharmacy), Phase II (long-term services and supports and waiver services excluding developmentally disabled waiver services), and Phase III (developmentally disabled waiver services).  Phase III is delayed until Phase II becomes operational in October 2012. (Source: State Website on Integrated Care Program)

The State’s second managed care program is called Care Coordination Innovations Project, which is projected to begin operation in January 2013 for older adults and adults with physical disabilities, and in April 2013 for children with complex needs.  Managed care entity will include Care Coordination Entity (CCE) and Managed Care Community Network (MCCN). A CCE is a collaboration of providers that develop and implement a Care Coordination model that meets the state’s guidelines. CCE project collaborators must include participation from hospital(s), Primary Care Providers, and mental health and substance abuse providers.  CCEs use a shared-risk model for care coordination. A Managed Care Community Network (MCCN) is a provider sponsored organization that contracts to provide Medicaid covered services through a risk-based capitation fee. Participation in a CCE or MCCN is voluntary. (Source: State Presentation on Innovations Project, 10/31/2011) For more information on the two managed care programs, such as rollout schedule, click here.
State Website on Care Coordination initiative

State Demonstration to Integrate Care for Dual Eligible Individuals

Illinois Medicare-Medicaid Alignment Initiative proposes to enroll full benefit Medicare‐Medicaid beneficiaries ages 21 and over in the Aged, Blind, and Disabled category of assistance in limited geographic area under capitated model. Institutional and HCBS waiver services for persons with developmental/intellectual disabilities are carved out.  Enrollment is voluntary with opt out.  Enrollment in the MMAI program is expected to start in the Fall of 2013. (Source: Demonstration Proposal; State Website on Medicare-Medicaid Alignment Initiative)

CMS announced on February 22, 2013 that Illinois would be the fourth state to enter into a Memorandum of Understanding (MOU) to test a new model for Medicare-Medicaid enrollees. This MOU will allow CMS and Illinois to implement the State’s Medicare-Medicaid Alignment Initiative to provide coordinated care to more than 135,000 Medicare-Medicaid enrollees in the Chicago and area and throughout central Illinois. According to the MOU, the State law requires moving 50% of all Medicaid beneficiaries from fee-for-service (FFS) to risk-based care coordination by January 2015, and the Demonstration will help support the transition. The Demonstration will begin on October 1, 2013. (Source: Centers for Medicare and Medicaid Services)
Memorandum of Understanding
State website on the demonstration

Health Homes

The State has submitted draft state plan amendment to CMS. (Source: Integrated Care Resource Center)

Indiana

Program Initiative for Indiana Dually-Eligible Members

According to the state website on the initiative, 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. Although Indiana has withdrawn its letter of intent for CMS Duals Demonstration, the State has been actively working to develop a program specifically designed to meet the needs of its dual population. A robust care coordination or case management component will be a fundamental part of the program. (Source: State website)

According to stakeholder meeting presentation by the Office of Medicaid Policy & Planning, the demonstration is likely to be risk-based managed care model inclusive of long term care services.  It is undecided whether the program will be statewide or will be pilot program in select areas, and/or will be phase in regionally over time.  At this time, the demonstration is not anticipated to include individuals enrolled in nursing homes at the time of open enrollment for the demonstration. It is also likely that Medicaid beneficiaries currently in nursing homes or being served under HCBS waivers will be not be included in the demonstration.  Beneficiary Outreach begins for enrollment by December 31, 2012. The time frame to begin implementation of the new initiative is July-October, 2013. (Source: State stakeholder meeting presentation)

Balancing Incentive Program

The Centers for Medicare & Medicaid Services (CMS) announced (9/4/2012) that Indiana will receive estimated $78.2 million of enhanced Medicaid funds.
BIP application (Submitted 7/5/2012)

Section 1915(i) State Plan Amendment

According to a State official, the state has recently submitted two 1915 (i) State Plan Amendments to CMS, one targeting adults with serious mental illness, and the other targeting children with serious mental illness. (Source: NASUAD)

Health Homes

According to the state, Division of Disability and Rehabilitation Services (DDRS) is working on draft of SPA (click here for more information).  The State is proposing a statewide implementation of health home services for individuals with a co-occurring developmental disability (DD) who are at risk for developing another chronic health condition.  Mental Health Stakeholders are currently developing a Health Home proposal for SMI. (Source: State website)

Health Homes Initiative Overview (5/18/2012)
Provider Quarterly Update (1/22/2013)

Iowa

State Demonstration to Integrate Care for Dual Eligible Individuals

The demonstration will provide full benefit Medicare-Medicaid enrollees with access to comprehensive coordinated care management through a Health Home model.  Delivery system design includes the Health Home model of care for members with chronic conditions; disease management targeting members with mental health and substance abuse service needs; and an ACO model.  The demonstration will implement statewide, and reimbursement model is described as “Health Home in a Fee-for-Service environment.” Proposed implementation date is January 1, 2013. (Source: Demonstration Proposal) Target population includes members with intellectual/developmental disabilities. (Source: NASDDDS Managed Care Tracking Report)

Health Homes

The Centers for Medicare and Medicaid Services (CMS) approved (6/8/2012) Iowa's State Plan Amendment (SPA) to implement Health Home services for members with chronic conditions. Effective July 1, 2012, qualified providers will begin to offer advanced services to members with two chronic conditions or one chronic condition and the risk of developing another. Services will include comprehensive care management, care coordination, health promotion, comprehensive transitional care, individual and family support services, and referral to community and social support services. (Source: Integrated Care Resource Center, State-by-State Health Home State Plan Amendment Matrix: Summary Overview, Updated June 2012; Kaiser Commission on Medicaid and the Uninsured, Medicaid Health Homes for Beneficiaries with Chronic Conditions, August 2012) For more information on Health Homes, see the State’s Demonstration Proposal for dual eligible.

Approved Health Home State Plan Amendment (6/8/2012)

Section 1915(i) State Plan Amendment

Habilitation Services is a program to provide Home and Community Based Services (HCBS) for Iowans with impairments typically associated with chronic mental illnesses. Services include case management, home-based habilitation, day habilitation, prevocational service, and supported employment. The program was approved in 2007.
Program website
State Plan Amendment (04/16/2007)

Balancing Incentive Program Grant Award

CMS announced (6/13/2012) that Iowa will receive estimated $61.8 million of enhanced Medicaid funds (2% enhanced rate).  When approved, the state must have finalized a work plan submitted by January 1, 2013.  The finalized work plan will have detailed descriptions of how the key components – NWD/SEP, CSA, and conflict-free case management – will be operationalized through October 11, 2015. During this time, the state must also demonstrate rebalancing of community LTSS expenditures to equal or exceed the expenditures spent for institutional LTSS. (Source: Iowa Medicaid Enterprise Endeavors Update)

BIP application (Submitted to CMS: 4/30/2012)
Iowa Medicaid Enterprise Endeavors Update (May 2012)
CMS Award Announcement (6/13/2012)

Kansas

Current Medicaid Managed LTSS Program

The Kansas Department of Health and Environment resubmitted (8/6/2012) application for KanCare Section 1115 Demonstration waiver to CMS. The resubmitted application revises and builds upon the Demonstration Project proposal initially submitted on April 26, 2012.  According to the resubmitted application, the waiver will proceed on two separate tracks.  In the first track, the State will work with CMS to develop and implement by 2013 an integrated care system, “KanCare,” to provide Medicaid and Children’s Health Insurance Program (CHIP) services, including long term services and supports (LTSS), through managed care to all beneficiaries.  In the second track, the State will begin discussions with CMS to implement a global waiver that will administer an outcome-based Medicaid and CHIP program under a per-capita block grant.  Groups to be included in the program are children with disabilities, adults with physical disabilities, adults with developmental/intellectual disabilities, and older persons ages 65 and older.  Waiver authority is being sought to move all Medicaid populations into a person-centered integrated care system by January 1, 2013.  (Source: Medicaid.gov; CMS and Truven Health Analytics, July 2012)

Waiver Application (Corrected link) (Submitted 8/6/2012)

Kansas awarded (6/27/2012) contracts to three health insurance companies to manage its Medicaid program.  KanCare will cover the medical, behavioral health, and long-term care services for all Medicaid consumers beginning January 1, 2013.  Long-term services for people with developmental disabilities will be launched January 1, 2014, while pilot programs will be allowed. (Source: Press Release, 6/27/2012)

Officials at the Kansas Department for Aging and Disability Services sent (8/15/2012) a memo to managers of local agencies that provide Medicaid case management services to encourage workers currently employed as case managers for physically disabled and elderly Medicaid enrollees to apply for similar jobs with the three insurance companies chosen to implement KanCare. (Source: Kansas Health Institute News, 8/17/2012)

KanCare was approved by CMS on December 27, 2012, and the implementation began on January 1, 2013. 

Approved Application (12/27/2012)

Health Homes

Health Homes is one of components built in KanCare Section 1115 demonstration waiver.  According to the waiver application, the state intends to implement health homes through managed care companies by the end of 2013 for people with severe and persistent mental illness, diabetes, or both, and by the end of 2014, all beneficiaries with complex needs will have a health home.  The state will work with the CMS Health Homes team to prepare a related State Plan Amendment.  The State plans to submit the SPA in July 2013.  For more information, please visit state website on health home. (Source: KanCare Section 1115 demonstration waiver application)

Louisiana

Section 1915(k) Community First Choice Option

The Department of Health and Hospitals Bureau of Health Services Financing and Office of Aging and Adult Services propose to replace the current Long-Term Personal Care Services (LT-PCS) Program by adopting provisions to establish Community First Choice Option services as a covered service under the Medicaid state plan. The LT-PCS Program shall be terminated upon the Centers for Medicare and Medicaid Services' approval of the corresponding Community First Choice Option (CFCO) state plan amendment. (Source: Louisiana Register, Louisiana Register  Vol. 38,  No.6,  June 20, 2012)

Notice of Intent (Louisiana Register, 6/20/2012)

Section 1915(i) state plan amendment

The Department of Health and Hospitals submitted (3/10/2011) Section 1915(i) state plan amendment to the CMS with effective date of January 1, 2012.  The covered service is Adult Behavioral Health Services concurrent with the Behavioral Health 1915(b) waiver under a capitated contract reimbursement methodology. The operating agency is Office of Behavioral Health (OBH) within Department of Health and Hospitals (DHH). The 1915(i) State Plan HCBS benefit targets the following populations: Persons with Acute Stabilization Needs (ASN), persons with Serious Mental Illness (SMI) persons with Major Mental Disorder (MMD), and persons who previously met any of the above and needs subsequent medically necessary services for stabilization and maintenance. (Source: State plan amendment )

Section 1915(i) State plan amendment
State Information on 1915 (i) program

On March 2012, the fee-for-service mental health rehabilitation services program was transitioned to the Louisiana Behavioral Health Partnership managed by a Statewide Management Organization (SMO). (Source: State website)

State Information on Louisiana Behavioral Health Partnership

Balancing Incentive Program

The Centers for Medicare & Medicaid Services (CMS) announced (3/15/2013) that Louisiana will receive an estimated $69.25 million in enhanced Medicaid funds (2% enhanced FMAP rate).  (Source: Balancing Incentive Program Award Letter, 3/15/2013)

BIP Application (2/8/2013)
BIP Award Letter (3/15/2013)

Health Homes

The State’s Health Homes State Plan Amendment has received approval from CMS. (Source: CMS Website)

Balancing Incentive Program

Maryland is the second state (after New Hampshire) to be awarded Balancing Incentive Program (BIP) funding.  CMS has awarded the Maryland Department of Health & Mental Hygiene $106.34 million through September 2015. Maryland’s approved work plan is available here. (Source: CMS Balancing Incentive Program website)
BIP application (2/10/2012)
Award Letter (3/20/2012)

Community First Choice

According to materials provided by the State, the Department of Health and Mental Hygiene plans to include all required and optional services allowed under proposed federal regulations. These services are Personal/Attendant Care, Personal Emergency Response Systems (PERS), Voluntary training for participants, Transition Services, and Services that increase independence or substitute for human assistance. Phase-in enrollment of CFC participants is projected to begin in July 2013.

State Website on Community First Choice

Massachusetts

Currently Operating Medicaid Managed LTSS Program

Massachusetts Senior Care Options provides eligible adults of age 65 and older primary, acute, behavioral, prescription drugs, and LTSS in capitated rate.  LTSS include nursing facility, adult foster care, group adult foster care, adult day health, and other community-based LTSS.  Enrollment is voluntary, and the program covers most part of the state. The program operates under Medicaid Section 1915(a) and 1915(c) authorities. (Source: CMS and Truven Health Analytics, July 2012)
State Website on Senior Care Options

State Demonstration to Integrate Care for Dual Eligible Individuals  (Approved 8/23/2012)

State Demonstration to Integrate Care for Dual Eligible Individuals is projected to cover full dual eligibles of ages 21-64.  The proposal currently carves out ICF/MR services, HCBS waiver services for persons with developmental disabilities, and HCBS waiver services for persons with brain injury. (Source: CMS and Truven Health Analytics, July 2012)  There will be intersection of the I/DD population with acute and behavioral health care needs. (Source: NASDDDS Managed Care Tracking Report)

CMS announced on August 23, 2012 that Massachusetts would be the first state to enter into a Memorandum of Understanding (MOU) to test a new model for Medicare-Medicaid enrollees. This MOU will allow CMS and Massachusetts to contract with an integrated care organization to oversee the care of 110,000 Massachusetts residents who are enrolled in both Medicare and Medicaid. (Source: Centers for Medicare and Medicaid Services) The demonstration will implement statewide beginning April 1, 2013. (Source: CMS Press Release, 8/23/2012)
Memorandum of Understanding

Michigan

Currently Operating Medicaid Managed LTSS Program

Under Section 1915(b) and 1915(c), Medicaid Managed Specialty Support & Services Program provides behavioral service and LTSS in capitated rate to adults with intellectual/developmental disabilities, adults with serious mental illness (SMI), children with intellectual/developmental disabilities, as well as children with serious emotional disturbance.  LTSS includes nursing facility, ICF/MR, personal care services, targeted case management, and HCBS waiver services for persons with developmental disabilities.  Enrollment is mandatory.  (Source: CMS and Truven Health Analytics, July 2012)

State Demonstration to Integrate Care for Dual Eligible Individuals 

Projected to begin in 2013, Michigan Integrated Care for People who are Medicare-Medicaid eligible will cover all dual eligibles, including children with disabilities, adults with physical disabilities, adults with developmental/intellectual disabilities, adults with serious mental illness (SMI), and older persons of age 65 and older. Enrollment is voluntary with opt out.  (Source: CMS and Truven Health Analytics, July 2012)   While already existing pre-paid inpatient health plans (PIHPs) will remain in place, if individuals with I/DD opt out of the demonstration, they will not receive the enhanced care coordination and linkages with acute care envisioned in the demonstration. (Source: NASDDDS Managed Care Tracking Report) The demonstration will use a capitated payment model and implement on a statewide basis with a rolling phase-in across geographic areas based on population. (Source: Demonstration Proposal) Although Michigan’s original plan was to implement the program statewide, the State has decided to go with a regionalized approach instead. The State aims to implement the program in January 2014 in four selected regions, with outreach, education, and enrollment starting in October 2013. (Source: Press Release, State of Michigan Department of Community Health, 1/17/2013)
Program Website

Health Homes

According to the state’s proposal for duals demonstration, the state is working to develop the health home concept with Prepaid Inpatient Health Plans (PIHPs), the entities that currently deliver Medicaid behavioral health and developmental disabilities benefit in the state.  The state anticipates that health homes will be part of the services delivery model. For persons who have an intellectual/developmental disability and those with serious mental illness or substance use disorder, the supports coordinator within the PIHP will be responsible for leading other members of the participant’s care team across the delivery system to ensure integration of physical and behavioral health care. PIHPs will be required to deliver all supports and services in the least restrictive setting, to use person-centered planning and to make self-determination arrangements readily available. (Source: Demonstration Proposal) 

Minnesota

Currently Operating Medicaid Managed LTSS Program

Under Medicaid authority 1915(b) and 1915(c), Minnesota Senior Care Plus has provided primary, acute, behavioral, prescription drugs services and LTSS in capitated rate to older adults of age 65 and over.  Enrollment is mandatory, while duals can choose Minnesota Senior Health Options (MSHO). Minnesota Senior Health Options (MSHO) provides the same services as Minnesota Senior Care Plus does to adults of age 65 and older who are eligible for both Medicaid and Medicare Parts A and B.  Enrollment is voluntary with opt in.  MSHO operates under 1915(a) and 1915(c).  (Source: CMS and Truven Health Analytics, July 2012)
State Website on Senior Care Plus
State Website on Senior Health Options

Reform 2020 Draft Section 1115 Waiver Proposal

The 2011 Minnesota Legislature directed the Department of Human Services (DHS) to develop a proposal to reform the Medical Assistance Program. Goals of the reform include: community integration and independence; improved health; reduced reliance on institutional care; maintained or obtained employment and housing; and long-term sustainability of needed services through better alignment of available services that most effectively meet people’s needs. (Source: State Register notice, page 1580, June 18, 2012)  According CMS, the State submitted (8/24/2012) the waiver application.  After preliminary review of the application, however, CMS has determined that the application has not met the requirements for a complete application. The state will revise its application and resubmit it to CMS following completion of its public notice requirements of the transparency regulations. The State recently resubmitted (11/21/2012) the application to CMS. (Source: Medicaid.gov)

Reform 2020 Section 1115 Demonstration Application (Draft)
Reform 2020 Section 1115 Demonstration Application (Resubmitted 11/21/2012)

State Website on Reform 2020 Section 1115 Waiver

Minnesota Long Term Care Realignment Section 1115 Demonstration Waiver (Pending as of 11/28/2012; Submitted 2/13/2012)

Minnesota has proposed to Minnesota Long Term Care Realignment Section 1115 Waiver to revise its nursing facility level of care criteria (LOC) up from its current minimum of one ADL or IADL, with additional changes to LOC criteria regarding clinical need, cognition/behavior and frailty/vulnerability. This will impact not only eligibility for nursing facilities, but also for three of the State's 1915(c) Home and Community-Based Services (HCBS) waivers: Community Alternatives for Disabled Individuals (CADI), Brain Injury (BI), and Elderly Waiver (EW). The State is also requesting Federal Financial Participation (FFP) for two limited benefit HCBS programs: Alternative Care Program (AC) and Essential Community Supports (ECS). AC serves individuals age 65 and older who meet the LOC criteria but whose income exceeds Medicaid standards, while ECS will serve individuals who do not meet the revised LOC criteria regardless of whether or not their income meets Medicaid standards. (Source: Medicaid.gov)
Waiver Application

According to state officials, under Minnesota Long Term Care Realignment Section 1115 Waiver, the State proposes to implement Section 1915(i) State Plan Amendment and Community First Choice under Section 1915(k).  Populations currently under consideration for inclusion in 1915(i) are persons with autism, adults with mental illness, and children with mental illness. (Source: NASUAD)

State Demonstration to Integrate Care for Dual Eligible Individuals (Withdrawn)

The state has decided (6/29/2012) not to pursue financial alignment demonstration, noting that Medicare financing under the financial alignment demonstration model would result in a significantly lower payment than Minnesota receives for senior Medicare beneficiaries in current programs. (Source: State Website on the demonstration). 

The first phase of the demonstration would include all full benefit dual eligible seniors 65 and over who qualify for Medicaid managed care enrollment and are enrolled in or choose to enroll in Minnesota Senior Health Options (MSHO) and Minnesota SeniorCare Plus (MSC+).  In the second phase of the demonstration, beginning July 2013 the State would include dually eligible people with disabilities of age 18-64 now enrolled in Special Needs BasicCare (SNBC).  Implementation will be statewide for seniors, and statewide contingent on further negotiations with CMS for people with disabilities. Both seniors and people with disabilities will receive Medicare Parts A, B, D and Medicaid State Plan services including mental health and CD treatment services.  Seniors will receive LTSS including Elderly Waiver (1915 (c) and all Medicaid PCA and Home Health under capitated model. Partial nursing facility (NF) services will also be included. People with disabilities will receive partial NF and LTSS (Personal Care Assistance, Private Duty Nursing, Community Alternative Care, Community Alternatives for Disabled Individuals, Brain Injury, Intellectual and Developmental Disabilities 1915(c) waivers under fee-for-service model. (Source: Demonstration Proposal) State website on the demonstration

State Initiative to Integrate Care for Dual Eligible Individuals

Minnesota Department of Human Services, Health Care and Continuing Care Administrations recently released (1/22/2013) Notice of Request for Public Input on its website for Demonstration to Integrate Care for Dual Eligibles. The purpose is to identify best practices for development of Integrated Care System Partnerships (ICSPs) between managed care organizations and primary, acute, long-term care and mental health providers serving seniors and people with disabilities under managed care programs. The ICSPs are especially for seniors and people with disabilities eligible for Medicare and Medicaid (dual eligible), including Minnesota Senior Health Options (MSHO), Minnesota Senior Care Plus (MSC+) and Special Needs BasicCare (SNBC). (Source: State Website)

State Register, Vol. 37, No. 30 (1/22/2013)

Section 1915(i) State Plan Amendment

Home Based Habilitation Services (HBHS) is an optional Medicaid State Plan service authorized under State Plan authority titled Nevada 1915(i) State Plan Home and Community-Based Services (HCBS).  The State Plan was amended in 2008 in response to the Deficit Reduction Act, Section 6086.  Home Based Habilitation Services (HBHS) are medically prescribed treatment for improving or restoring functions, which have been impaired by illness or injury or, where function has been permanently lost or reduced by illness or injury.  Services include Home and Community Based (HCBS) Adult Day Health Care, Habilitation, and Home and Community Based Services (HCBS) Day Treatment or Other Partial Hospitalization Services for Individuals with Chronic Mental Illness.
State Plan Amendment Medicaid Services Manual (updated 02/15/2012)

Health Homes

CMS approved planning request. (Source: Integrated Care Resource Center)

New Hampshire

Medicaid Managed LTSS Program (Approved 8/24/2012) & State Initiative to Integrate Care for Dual Eligible Individuals

As required in Senate Bill 147 passed by the New Hampshire Legislature on June 2, 2011, the Department of Health and Human Services Department submitted (3/31/2012) state plan amendment to the CMS through the 1932(a) State Plan option for authorization of the implementation of a state wide managed care delivery system, called New Hampshire Medicaid Care Management Program.  On May 9, 2012, members of the governor's Executive Council approved a $2.3 billion contract establishing a managed care system for Medicaid recipients. CMS approved (8/24/2012) the state plan amendment.

The care management system will be launched in three phases over the course of three years.  In Phase 1, all Medicaid patients in the state will be required to enroll in one of the new care management plans offered by the MCOs.  Beneficiaries eligible for both Medicare and Medicaid has option to opt out during Phase 1. For more information for populations served by the program, click here. LTSS will be added in Phase 2, currently estimated to begin January, 2014.  Groups projected to be enrolled by January 1, 2014 include children with physical, cognitive, or behavioral disabilities, adults with physical disabilities, adults with developmental/intellectual disabilities, and older persons.  Enrollment is mandatory.  In the last phase, the program will include those who are newly eligible for Medicaid benefits by the Affordable Care Act.  1 percent of each Medicaid enrollee's capitated payment will be withheld by the state and repaid to the MCOs only if they satisfy performance measures. (Source: Care Management Program Website; CMS and Truven Health Analytics, July 2012)
Care Management Program Website
Care Management State Plan Amendment (3/30/2012)
Approval Letter from CMS (8/24/2012)
Office of the Governor Press Release (8/30/2012)
January 2013 Care Management Update (1/24/2013)

Balancing Incentive Program

New Hampshire is the first state to apply for and to receive CMS approval for Balancing Incentive Program (BIP).  The state has been awarded $26.5 million of enhanced Medicaid funds. (Source: Award Letter) The state submitted final work plan to CMS. (Source: CMS official at CMS Meeting with Associations, July 17-18, 2012) Approved work plan is available here. (Source: CMS Balancing Incentive Program website)
BIP application (12/30/2011)

Award Letter (3/1/2012)

New Jersey

Projected Medicaid Managed LTSS Program (Approved 10/2/2012) & State Initiative to Integrate Care for Dual Eligible Individuals

New Jersey 1115 Comprehensive Waiver (Approved 10/2/2012; Submitted 9/9/2011) seeks to provide State plan benefits as well as long term care services and supports to Medicaid and CHIP beneficiaries. The 1115 demonstration combines authority for several existing Medicaid and CHIP waiver and demonstration programs, including two 1915(b) managed care waiver programs; a title XIX Medicaid and a title XXI CHIP section 1115 demonstrations and four 1915(c) programs. The first phase includes the non-dual population of aging, blind and disabled Medicaid beneficiaries, populations served by the Department of Developmental Disabilities (DDD) including Community Care Waiver clients, clients already covered by a commercial or Medicare HMO, and breast or cervical cancer clients.  The second stage includes all dual eligibles, an increased range of waiver clients, clients with traumatic brain injury, and those clients participating in the AIDS Community Care Alternatives Program and Community Resources for People with Disabilities. (Source: Waiver Application)

Comprehensive Medicaid Waiver Website
Waiver Application (9/9/2011)
Approval Letter (10/2/2012)
Recommendations by workgroup

According to a State official, the State proposed to add nursing home and HCBS to Managed Care contracts for Medicaid-eligible individuals who meet a NF level of care.  The State also worked with CMS on Special Terms and Conditions and Budget Neutrality. (Source: NASUAD Membership Meeting, 9/9/2012)

According to Press Release (10/4/2012) from the State Department of Human Services, some of reform proposals in the application were denied by CMS, including the following: the State’s request to no longer provide retroactive Medicaid eligibility for applicants; consolidation of all nine state waivers into one, and the state’s appeal for an estimated $107 million in Medicare Part B retro payment for Medicare services erroneously billed to Medicaid. The federal government also determined that approval of future programmatic changes and that the Community Care Waiver will remain outside the comprehensive waiver. (Source: Press Release, State of New Jersey Department of Human Services, 10/4/2012)

Balancing Incentive Program

The Centers for Medicare & Medicaid Services (CMS) recently approved (3/15/2013) New Jersey’s Balancing Incentive Program Application. (Source: CMS Website)

BIP Application (12/20/2012)

Health Homes

CMS approved planning request. (Source: Integrated Care Resource Center)

Currently Operating Medicaid Managed LTSS Program

Since 2008, Coordination of Long-Term Services (CoLTS) has provided LTSS to children with LTSS needs, adults less than age 65 with physical disabilities, and adults of age 65 and older through State Plan Personal Care Options and 1915(c) HCBS waivers.  The State is currently seeking to merge CoLTS with Salud! (Medicaid managed care for other populations) and the State’s behavioral health carve out plan via a Section 1115 demonstration waiver. (Source: CMS and Truven Health Analytics, July 2012)
State Resource on Coordination of Long-Term Services (CoLTS)

Projected Medicaid Managed LTSS Program

New Mexico submitted (8/17/2012) a Section 1115 Medicaid demonstration proposal entitled Centennial Care.  According to information provided by the state, Centennial Care proposes to create a comprehensive managed care delivery system in New Mexico under which contracted health plans will offer the full array of current Medicaid services, including acute, behavioral health, home and community based and long term institutional care.  This proposal would combine existing section 1915(b), 1915(c), and 1115 waivers under a comprehensive demonstration project. 
Waiver application (Submitted 8/17/2012)
State Website on Centennial Care
Centennial Care Concept Paper

Proposed rule of the Human Services Department, Medical Assistance Division, amends regulations to align the Behavioral Health Collaborative standards with the health services delivery model of New Mexico Centennial Care. The rule allows for multiple providers of behavioral health services instead of a single statewide behavioral health provider. For more information, please click here. (Source: BNA’s State Health Care Regulatory Developments, 9/18/2012) To check on the program’s most recent progress, click here.

State Demonstration to Integrate Care for Dual Eligible Individuals (Withdrawn)

Department of Human Services submitted (8/7/2012) a letter to CMS withdrawing the State’s previous proposal seeking permission to conduct this demonstration. In the demonstration proposal submitted on May 31, 2012, the State had proposed that dually-eligible individuals receiving services through the New Mexico Developmental Disabilities waiver would receive their regular medical benefits through the demonstration, but that their long-term care services would remain carved out of managed care and paid through a fee-for-service arrangement. 
Demonstration Proposal
Letter to CMS to notify withdrawal (8/17/2012)

Health Homes

New Mexico seeks to establish health homes as an integral step in the integration of care under the Section 1115 demonstration waiver. The State is currently working with a 2703 planning grant to design its first SPA to establish health homes throughout the State that address recipients with a behavioral health condition. It is the State’s intent to develop health homes in Core Service Agencies (CSAs) statewide. This model for behavioral health homes (BHH) is being designed in conjunction with the MCOs under Centennial Care. Once a recipient is enrolled in a BHH, the responsibility for both care management and care coordination is delegated by the MCO to the BHH. Over time, the State intends to establish health homes for other chronic conditions through the SPA process. The State will work to closely coordinate the health home model(s) with Centennial Care to ensure the integration of care is achieved at all levels. (Source: Centennical Care Section 1115 Demonstration Waiver Application)

New York

Currently Operating Medicaid Managed LTSS Program

New York Medicaid Advantage Plus (MAP), operating under Medicaid Section 1915(a), provides LTSS in capitated rate to adults age 18-64 with physical disabilities and adults of age 65 and older. Enrollment is voluntary with opt in. (Source: CMS and Truven Health Analytics, July 2012) 

Partnership Plan Waiver & Federal-State Health Reform Partnership (F-SHRP) waiver

In 1997, the State received approval from the federal government of its first Section 1115 demonstration waiver known as the Partnership Plan.  Since the original approval and subsequent amendments, the Partnership Plan Demonstration currently consists of four major program components: 1. Medicaid Managed Care providing Medicaid State Plan benefits through comprehensive MCOs to most recipients eligible under the State Medicaid Plan; 2. Family Health Plus providing a more limited benefit package, with cost-sharing imposed, for adults with and without children with specified income; 3. Family Planning Benefit Program serves men and women who are otherwise not eligible for Medicaid but are in need of family planning services who have net incomes at or below 200 percent of the federal poverty level (FPL) and to women who lose Medicaid eligibility at the end of their 60-day postpartum period; and 4. Home and Community-Based Services Expansion providing an expansion of three 1915(c) waiver programs by eliminating a barrier to financial eligibility to receive care at home.

The Partnership Plan Demonstration operates separately from, and complements, New York’s Federal-State Health Reform Partnership (F-SHRP) Section 1115 Demonstration. 

New York Federal-State Health Reform Partnership (F-SHRP) was the State’s second demonstration waiver approved by CMS.  The demonstration provides federal financial support for a health reform program in New York that addresses the State’s need to modernize its acute and long-term care infrastructure, increase capacity in primary and ambulatory care, and make investments in health information technology. The demonstration also allows the State to enroll certain Medicaid populations into managed care on a mandatory basis: aged, blind and disabled individuals statewide, and children, caretaker relatives, and pregnant women in selected counties. (Source: Medicaid.gov)

State Website on Partnership Plan Waiver
State Website on Federal-State Health Reform Partnership
Fact Sheet on F-SHRP

CMS approved (8/31/2012) the State’s recent application for amendments to Partnership Plan and F-SHRP.  Click here to see approval letter.  The State requested (10/31/2012) the federal government for extension of Partnership Plan beyond its current 12/31/2014 expiration date to 12/31/2017.  The application for extension includes an interim evaluation of the Partnership Plan.

Medicaid Redesign Team (MRT) Waiver

The MRT waiver is an amendment to the state’s existing Section 1115 Demonstration waiver, Partnership Plan. The State recently submitted (8/6/2012) Medicaid Redesign Team (MRT) waiver, which will allow the State to invest up to $10 billion of $17.1 billion in federal savings generated by the Medicaid Redesign Team (MRT) reforms over a five-year period. The MRT waiver amendment will be restricted to the portion of the Medicaid program controlled by the Department of Health. Specifically excluded from the 1115 waiver amendment are those Medicaid services provided through waivers administered by the Office for People with Developmental Disabilities (OPWDD). The state is currently pursuing a different waiver agreement that will encompass services/waivers that relate to people with developmental disabilities. Both this waiver and the OPWDD waiver will rely on care management as the primary method for driving change and innovation. More information on the Medicaid 1115 waiver is available at State Website on Medicaid Redesign. (Source: Medicaid Redesign Team (MRT) waiver application)

Medicaid Redesign Multi-year Action Plan

State Demonstration to Integrate Care for Dual Eligible Individuals

The State proposes to offer integrating care for the dual eligible population through two models: (1) Managed Care Model (Fully-Integrated Duals Advantage; FIDA), and (2) Managed Fee-for-Service Model (Health Homes). 

Beginning in January 2013, the Managed Fee-for-Service (FFS) Health Home program would provide care coordination for the high-needs, high cost, dual eligible Medicaid population that have complex medical, behavioral, social service and long term care needs requiring less than 120 days of long term care services. Managed FFS dual eligible Health Home members are eligible for Medicare (Part A, B and D) and Medicaid State Plan services provided via FFS.  The program would operate statewide.

Built off of the State’s Medicaid Advantage Plus program, Fully-Integrated Duals Advantage (FIDA) program would cover full dual eligibles (age 21 or older) who require 120 or more days of Long-Term Supports and Services (LTSS).  Starting January 2014, these individuals would be provided the entire range of Medicare and Medicaid services as well as an extensive list of LTSS many of which were previously only available in New York State’s Home and Community-Based Services Waiver programs. The FIDA program would serve eight NY counties of Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk, and Westchester. 

Full dual eligible (age 21 or older) who are receiving services through the Office of Persons with Developmental Disabilities (OPWDD) system will be served under FIDA OPWDD statewide. Developmental disabilities waiver services and ICF/MR services will only be included in FIDA OPWDD program.  (Source: CMS and Truven Health Analytics, July 2012; New York State Department of Health’s Demonstration to Integrate Care for Dual Eligible Individuals)

Health Homes

New York Health Home State Plan Amendment for Individuals with Chronic Behavioral and Mental Health Conditions  (approved 2/3/2012) targets Medicaid enrollees with two or more chronic conditions; or HIV/AIDS and a risk of developing another chronic condition; or one serious mental illness.  The initiative does not include those receiving long-term care and those with intellectual disabilities, and the State intends to seek approval of a separate health home SPA that will specifically target these populations.  Enrollment began in February 2012. (Source: State Website on Health Homes)

State Plan Amendment
State Website on Medicaid Health Homes (April 2012)
State Website on Medicaid Health Homes (November 2012)

New York State Medicaid Director Testified before the U.S. Senate on its Medicaid Redesign and Duals Demonstration (7/18/2012)
Complete Testimony

Projected Medicaid Managed LTSS Program

Medicaid Redesign Team Proposal #90 and 2011 budget legislation requires the transition and enrollment of certain community-based long term care services recipients into Managed Long Term Care Plans (MLTCPs) or Care Coordination Models (CCMs). New York State currently operates three models of MLTCP: the Program of All-Inclusive Care for the Elderly (PACE); Medicaid Advantage Plus (MAP); and partially capitated managed long term care plans. Currently there are no CCMs established. All models provide community-based long term care services, nursing home care and many ancillary services, including individualized care management. During July 2012, the Department received verbal approval from the Centers for Medicare and Medicaid Services (CMS) to initiate mail distribution of mandatory enrollment notifications. These notifications, alerting current members that they must choose a plan to continue receiving community based long-term care services, are being rolled out in New York City using a phased approach by borough and zip code. On August 31, 2012, the Department received written approval from CMS to proceed with auto-assignment of members into partial capitated managed long term care plans in New York City.  The mandatory enrollment initiative will continue within the five boroughs of New York City until all eligible cases are transitioned. In January 2013, the initiative will move to Nassau, Suffolk and Westchester counties. (Source: State Medicaid Update, September 2012)

State Website on Managed Long Term Care/Care Coordination Model

Projected Medicaid Managed LTSS Program

New York People First Waiver (Pending as of 11/28/2012):  The target population for the People First Waiver is Medicaid enrollees of all ages with developmental disabilities. The State proposes to develop and implement creative service delivery and payment models that integrate acute and long-term care to achieve improved health outcomes and quality of care while lowering health care costs for the developmentally disabled population. (Source: Medicaid.gov) 

Mandatory services provided in capitation rate will include (1) family and individual support, integration and community habilitation, flexible goods and services, home and community-based clinical and behavioral supports; (2) Adult Day Health Care; (3) Assisted Living Facility; (4) Home Care (Nursing, Home Health Aide, PT, OT, SP, Medical Social Services); (5) ICF/MR; and (6) Skilled Nursing Facility.  Pilot projects are projected to begin in October 1, 2012.  Statewide launch of partial and fully capitated DISCOs begins in Summer 2015. (Source: New York’s Response to Centers for Medicare & Medicaid Services’ Request for Additional Information, April 2012)  Enrollment is voluntary in pilot phase, and becomes mandatory when fully implemented. (Source: CMS and Truven Health Analytics, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012)

State Website on New York People First Waiver

New York’s Response to CMS’ Request for Additional Information (April 2012)

Balancing Incentive Program

The Centers for Medicare & Medicaid Services (CMS) announced (3/15/2013) that New York will receive an estimated $598.7 million in enhanced Medicaid funds (2% enhanced FMAP rate).  (Source: State Website)
BIP Application (12/20/2012)
Revised BIP Application (2/26/2013)

Currently Operating Medicaid Managed LTSS Program

MH/DD/SAS Health Plan Waiver (formerly Piedmont Cardinal Health Plan – Innovations (PCHP)), under Section 1915(a) authority, began operating in 2005 as a five-county pilot, and is scheduled to become statewide in 2013.  The program targets Children and adults of all ages with serious emotional disturbance, developmental disabilities, mental illness, or substance abuse disorders. Services provided in capitated rate are inpatient and outpatient behavioral health (mental health and substance abuse), including enhanced community services, Psychiatric Residential Treatment Facilities (PRTFs), Emergency Room visits for behavioral health treatment, and LTSS (ICF/MR, HCBS waiver services for persons with developmental and intellectual disabilities, Therapeutic Foster Care (TFC), Residential Child Care).  (Source: CMS and Truven Health Analytics, July 2012)
State Website on MH/DD/SAS Health Plan Waiver

State Demonstration to Integrate Care for Dual Eligible Individuals

The State’s demonstration targets full benefit dual eligible beneficiaries, age 21 and older. It does not include individuals with mental health, intellectual/developmental disabilities, and substance abuse needs receiving services under Medicaid Prepaid Inpatient Health Plan (PHIP)/1915 (b)/(c) Medicaid Waiver. It will implement statewide using a managed fee-for-service reimbursement model. (Source: Demonstration Proposal; State Website on Duals Demonstration)

Section 1915(i) State Plan Amendment

The State has submitted two 1915 (i) State Plan Amendments.  The first program proposes to provide Personal Assistance Services, which consists of assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) for three distinct target populations: individuals with physical disabilities; adults with a diagnosis of mental illness, mental retardation/developmental disability, or dementia; and elderly individuals with functional disabilities. The Consolidated Personal Care Services (PCS) program is designed to provide personal care services to individuals residing in a private living arrangement, or a residential facility licensed by the State of North Carolina as an adult care home, or a combination home as defined in G.S. 131E-101(1a).G.S. 131E-101(1a); or resides in a group home licensed under Chapter 122C of the General Statutes and under 10A NCAC 27G .5601 as a supervised living facility for two or more adults whose primary diagnosis is mental illness, a developmental disability, or substance abuse dependency. Effective date is January 1, 2013. (Source: North Carolina Department of Health and Human Services)
State Plan Amendment (Submitted 04/30/2012)
Consolidated Personal Care Services (PCS) state website

The second program, titled “Alzheimer’s and Dementia Services,” proposes to target Medicaid eligible individuals of 21 years or older with one of the following primary diagnoses: Alzheimer’s Disease, Vascular Dementia, Dementia with Lewy Bodies, Pick’s Disease, Parkinson’s Disease, Creutzfeldt-Jakob Disease, or Huntington’s Disease. The benefit consists of hands-on, supervision, set-up, and cueing assistance with qualifying ADLs and associated IADLs; medication assistance; medical monitoring; assistance with durable medical equipment and adaptive and assistive devices; and safety monitoring and supervision. Activities of daily living, for the purposes of this benefit, are bathing, dressing, mobility, toileting, and eating. Instrumental activities of daily living are basic home management tasks that are directly related to the qualifying ADLs and essential to the beneficiary’s care at home.  (Source: State Plan Amendment, Submitted 9/17/2012)

Health Homes

North Carolina Health Home State Plan Amendment (approved 5/24/2012) targets beneficiaries with two chronic medical conditions or one and at risk of another condition. The State also adds ten qualifying conditions to the list, including blindness, congenital anomalies, and chronic neurological diseases. Enrollment in the program is voluntary through Community Care of North Carolina (CCNC), which will provide health home services.  (Source: Integrated Care Resource Center, State-by-State Health Home State Plan Amendment Matrix: Summary Overview, Updated June 2012; Kaiser Commission on Medicaid and the Uninsured, Medicaid Health Homes for Beneficiaries with Chronic Conditions, August 2012)

The SPA will expire in October 2013. (Source: Demonstration Proposal)

State Demonstration to Integrate Care for Dual Eligible Individuals & Medicaid Managed LTSS Program

CMS announced on December 12, 2012 that Ohio would be the third state to enter into a Memorandum of Understanding (MOU) to test a new model for Medicare-Medicaid enrollees. Ohio and CMS will contract with Integrated Care Delivery System (ICDS) plans that will oversee and be accountable for the delivery of covered Medicare and Medicaid services for approximately 115,000 Medicare-Medicaid enrollees in seven regions of the state. (Source: Centers for Medicare and Medicaid Services)  The plans will serve most dual eligible age 18 and older in 29 targeted counties (out of a total 88 counties statewide), and will not include persons with intellectual or developmental disabilities who are otherwise served in 1915(c) HCBS waiver programs or in ICF/MR facilities. (Source: CMS and Truven Health Analytics, July 2012; State Website)  According to an updated timeline posted on the State website, voluntary enrollment in the plans will begin September 1, 2013.  (Source: State Website) The demonstration will implement in seven regions composed of three to five counties each, and will use a capitated financial alignment model. (Source: Demonstration Proposal)

State Website on Integrated Care Delivery System
Notice of delay in implementation (10/5/2012)
CMS Press Release (12/12/2012)
Memorandum of Understanding

Health Homes

The State’s Health Homes State Plan Amendment was approved on September 17, 2012.   According to duals demonstration proposal, Ohio State Medicaid agency has been working with CMS on the state plan amendment to create Health Homes for Medicaid beneficiaries who meet the State’s definition of serious and persistent mental illness, or SPMI (including adults with serious mental illness, or SMI, and children with serious emotional disturbance, or SED) in five sites (Butler County, Adams County, Scioto County, Lawrence County, and Lucas County), effective October 1, 2012.  (Source: CMS Approval Letter) The State will expand the services statewide next Spring. (Source: NASUAD)  The SPA is expected to enhance the traditional patient‐centered medical home to better coordinate physical and behavioral health services. Community behavioral health centers (CBHCs) will be eligible to apply to become Medicaid health homes for individuals with SPMI. At a later date, Ohio Medicaid will implement Medicaid Health Homes focusing on individuals with qualifying chronic physical health conditions. (Source: Duals demonstration proposal)
Health Homes State Plan Amendment (Medicaid Model Data Lab)
Approval Letter (9/17/2012)

State Medicaid Health Homes Website

Oregon

State Demonstration to Integrate Care for Dual Eligible Individuals (Withdrawn)

The State submitted its proposal to CMS on May 11, 2012, but decided not to pursue the demonstration as  currently described, which would have relied on a  capitated payment model. Oregon Health Authority (OHA) has determined that the demonstration is not likely to be financially viable for Oregon’s Coordinated Care Organizations (CCOs) and their affiliated Medicare Advantage plans. OHA will explore the feasibility of a modified demonstration with CMS, focusing on delivery system reforms underway in CCOs, paired with Medicare/Medicaid administrative alignments,without the proposed financial component of the financial alignment demonstration. (Source: State website on the demonstration)

Demonstration Proposal
State website on the demonstration
Letter to Coordinated Care Organizations and Stakeholders (10/30/2012)

Amendment to Oregon Health Plan Section 1115 Demonstration Waiver (Approved 7/5/2012; Submitted to CMS 3/1/2012)

Oregon Health Plan 2 Section 1115 Demonstration provides coverage to mandatory and optional State Plan populations through the OHP Plus benefits package, and expands populations with a limited benefits package through OHP Standard. Medicaid eligibles may also elect to receive benefits through a premium assistance program which allows individuals to purchase coverage through the commercial insurance market. (Source: Medicaid.gov)

The state (3/1/2012) submitted a Request for Amended Waiver to CMS to seek federal flexibility in several areas including the following: (1) Alternative payment methodologies to reimburse providers on the basis of outcomes and quality through shared savings and incentives; (2) Ability to reimburse non-traditional health care workers such as community health workers, peer wellness specialists, Duals, and personal health navigators; (3) Flexibility to provide services that may not always traditionally be reimbursed as a Medicaid State Plan service but help keep people living in the community; (4) Developing an alternative payment methodology to allow a unique prospective payment system/alternative payment methodology for Federal Qualified Health Centers. (Source: Oregon Division of Medical Assistance Programs Update)
Application for Amendment and Renewal (3/1/2012)

The amendment was approved (7/5/2012) by CMS.  The demonstration has been extended through June 30, 2017. Under the demonstration, Oregon will launch new Coordinated Care Organizations (CCOs), which are managed care entities that will operate on a regional basis, with enhanced local governance and provider payment structures that promote transparency and accountability.  CCOs will replace the specialized managed care entities currently contracted through the Oregon Health Plan. (Source: Current Approval Document, 7/5/2012)

Program Website

Coordinated Care Organizations

On May 3, 2012, the U.S. Department of Health and Human Services (HHS) has given the state preliminary approval of a five-year, $1.9 billion demonstration program to create Coordinated Care Organizations (CCOs) in the state's Medicaid program, which Oregon estimates will save $11 billion over coming years by setting a "global budget" for the state's Medicaid program and lowering the percentage it will grow each year.

Press Release (5/3/2012)
State information on Coordinated Care Organization 1
State information on Coordinated Care Organization 2
Senate Bill 1580 (2012 CCO Implementation)
HB 3650 (2011 CCO Creation)    

Health Homes

Oregon’s Health Homes State Plan Amendment was approved by CMS on 3/13/2012.  Oregon’s Health Homes targets individuals with two chronic conditions, one chronic condition and a risk of developing another, or one serious mental illness. Services are offered statewide. (Source: Kaiser Commission on Medicaid and the Uninsured, Medicaid Health Homes for Beneficiaries with Chronic Conditions, August 2012)

Section 1915(i) State Plan Amendment
Section 1915(i) state plan option was approved on February 14th, 2012. Covered services include Home Based Habilitation, HCBS Behavioral Habilitation, HCBS Psychosocial Rehabilitation for persons with Chronic Mental Illness (Source: DMAP Update, March 2012)

Currently Operating Medicaid Managed LTSS Program

Since 2009, Pennsylvania has provided Adult Community Autism Program to adults of age 21 or higher with diagnosis of Autism Spectrum Disorder under the authority of Medicaid Section 1915(a). Services included in the capitation rate are primary, behavioral, dental, ICF/MR, targeted case management, adult day, and occupational therapy/physical therapy/speech therapy (OT/PT/ST). The program is operating in four (out of 67) counties, and enrollment is voluntary.  (Source: CMS and Truven Health Analytics, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012)

State Demonstration to Integrate Care for Dual Eligible Individuals

Under the demonstration titled Integrated Care for Medicare and Medicaid Beneficiaries, the State proposes to enroll approximately 12,000 Medicaid-only enrollees and 23,000 Medicare-Medicaid enrollees.  Services for persons with Intellectual/developmental disabilities and persons with serious mental illness are carved out in 2013, with possibility of being included in 2014. (Source: CMS and Truven Health Analytics, July 2012)
Demonstration Proposal

Health Homes

Rhode Island has two approved health home state plan amendments implemented statewide, effective October 1, 2011. Rhode Island Community Mental Health Organization Health Homes State Plan Amendment (approved 11/23/2011) targets individuals with a serious and persistent illness (SPMI). Rhode Island CEDARR Family Center Health Homes State Plan Amendment (approved 11/23/2011) is for children and youth under age 21 with diagnosis of severe mental illness or serious emotional disturbance, or with two of the following chronic conditions, or have one and at risk of developing another: mental health condition, asthma, diabetes, DD, Down syndrome, mental retardation, or seizure disorder. (Source: Integrated Care Resource Center, State-by-State Health Home State Plan Amendment Matrix: Summary Overview, Updated June 2012; Kaiser Commission on Medicaid and the Uninsured, Medicaid Health Homes for Beneficiaries with Chronic Conditions, August 2012)

State Demonstration to Integrate Care for Dual Eligible Individuals

South Carolina Dual Eligible Demonstration (SCDuE) is projected to enroll full benefit Medicare-Medicaid enrollees who are 65 years of age and older, not living in institutions at time of enrollment, and not enrolled in a PACE program by January 1, 2014.  Enrollment is voluntary with opt out, and there will be no exclusions based on diagnosis or condition(s).  The State initially had HCBS waiver services carved out.  However, as of April 12, 2013, the proposed model has been changed to reflect a carve-in of home and community based services (HCBS). The program will operate statewide by July 2014.  (Source: State Website on Duals Demonstration; Demonstration Proposal; CMS and Truven Health Analytics, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012)  Individuals with intellectual/developmental disabilities are not included in the demonstration. (Source: NASDDDS Managed Care Tracking Report)
Demonstration Proposal

Tennessee

Currently Operating Medicaid Managed LTSS Program

Under TennCare II Section 1115 Demonstration Waiver, TennCare CHOICES provides primary, acute, behavioral, nursing facility, and HCBS waiver-type services to eligible persons of all ages residing in nursing homes, adults under age 65 with physical disabilities, and adults age 65 and higher.  At inception in 2010, LTSS was added to the existing TennCare managed care demonstration.  The program is operating statewide, and enrollment is mandatory. (Source: CMS and Truven Health Analytics, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012)

State Website on TennCare CHOICES

Amendment to TennCare II Section 1115 Demonstration Waiver (Approved 6/15/2012; Extension request submitted 6/29/2012)

Under this demonstration, all Medicaid State plan eligibles (except those eligible only for Medicare premiums) are enrolled in TennCare Medicaid and receive most of the State plan services through the demonstration's managed care delivery system. The recently submitted amendment pertains to the CHOICES program, which is Tennessee’s Medicaid managed long-term care program.  CHOICES serve three groups: CHOICES 1 serves nursing facility residents; CHOICES 2 serves elderly adults or adults with physical disabilities who meet nursing facility level of care, but who have elected to receive home and community based services; CHOICES 3 serves elderly adults or adults with physical disabilities who do not meet nursing facility level of care, but are “at risk” for institutionalization. The amendment seeks to increase the enrollment target for CHOICES 2, effective July 1, 2012. (Source: Medicaid.gov & application to CMS) 
Application for Amendment

Amendments #14 and #16 for the demonstration were approved by CMS (6/15/2012).  Amendment #14, effective as of July 1, 2012, authorizes an increase to the enrollment targets for the CHOICES 2 program and approves the rebalancing of the CHOICES managed long-term care program and the creation of Interim CHOICES 3. Amendment #16 pertains to Disproportionate Share Hospital allotment. The Department of Finance and Administration submitted a  three-year extension request to CMS on 6/29/2012. (Source: Centers for Medicare & Medicaid Services)
Current Approval Document
Three-year Extension Request Document

State Demonstration to Integrate Care for Dual Eligible Individuals (Withdrawn)

Tennessee recently submitted (12/21/2012) a letter to Medicare-Mediciad Coordination Office requesting to withdraw its financial alignment demonstration proposal. In the letter, the state expressed their concerns pertaining to the reimbursement methodology. (Source: Letter to Medicare-Mediciad Coordination Office). Tennessee’s duals demonstration TennCare PLUS proposes to enroll full benefit dual eligibles, except PACE participants, starting January 1, 2014, statewide.  The demonstration will not include LTSS for persons with intellectual disabilities (including ICF/MR and Section 1915(c) waiver services), but dual eligible members receiving these services will be part of the demonstration for all other Medicare and Medicaid services. The demonstration will operate under a capitated payment model. For more information, click here. (Source: Demonstration Proposal; State Website)

Texas

Currently Operating Medicaid Managed LTSS Program

Through Medicaid Section 1115 authority, Texas STAR+PLUS (inception: 1998) provides primary, acute, behavioral, and LTSS (Personal Attendant, Assisted Living, PERS, nursing, Adult Foster Care, dental, respite, home-delivered meals, OT/PT/ST, consumer directed services, home mods, medical supplies) to eligible adults age 21 and older with disability (SSI), adults age 21 and older in Community-based alternatives HCBS waiver, adults age 65 and older, and full-benefit Medicare-Medicaid enrollees. Certain groups are excluded, such as people living in nursing facilities, ICFs-MR, and in HCBS waivers other than the community-based alternatives waiver. Enrollment is mandatory for full-benefit Medicare-Medicaid enrollees. (Source: CMS and Truven Health Analytics, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012)
Program Website

Under Healthcare Transformation and Quality Improvement Program Section 1115 demonstration waiver (Approved 12/12/2011), the State is expanding STAR and STAR+PLUS (MMLTC) statewide and using savings from the expansion of managed care and the discontinuation of supplemental provider payments to finance new funding pools to assist hospitals and other providers with uncompensated care costs and to promote delivery system transformation and improvement.

The Texas Health & Human Services Commission submitted a request for amendment on 5/3/2012, wherein it proposes to add Day Activity Health Services to the existing STAR+PLUS waiver, effective September 1, 2012. The service targets individuals who are eligible for the STAR+PLUS waiver and exceed the financial requirements for Day Activity and Health Services under the 1915(i) authority.  Services include nursing and personal care, physical rehabilitation, noon meal and snacks, social, educational and recreational activities, and transportation. (Source: Medicaid.gov)
Current Approval Document
Request for amendment (submitted 5/3/2012)

The Texas Health and Human Services Commission (HHSC) is adopting new permanent payment rules that implement the provider eligibility requirements and payment methodologies approved by CMS under Healthcare Transformation and Quality Improvement Program waiver. (Source: Texas Register, June 22, 2012)
State information on the adopted rules

State Demonstration to Integrate Care for Dual Eligible Individuals

Texas’ Dual Eligible Integrated Care Model targets full dual eligible adults, who are required to participate in STAR+PLUS. The demonstration will implement in all STAR+PLUS services areas, with the possibility of phased-in implementation, beginning with the most populous counties, starting January 1, 2014.  Capitated Medicaid Managed Care Organizations will offer a full array of Medicaid and Medicare services for the targeted population. (Source: Demonstration Proposal) A Texas State Official, however, confirmed that the demonstration would be implemented in limited geographic areas, i.e., 19 counties with the largest number of dually eligible beneficiaries. (Source: NASUAD) Individuals with intellectual/developmental disabilities are fully carved out of this demonstration. (Source: NASDDDS Managed Care Tracking Report)

Cost-sharing methodology for Dual Eligibles

HHSC also amends regulations regarding the coordination of Medicaid with Medicare Parts A, B, and C. The rule authorizes the commission to make higher cost-sharing payments for dual eligibles for certain services if the commission determines that a higher payment amount is necessary to ensure adequate access to care or would be more cost-effective to the state. HHSC will have to request and receive approval for a Medicaid State Plan amendment from the Centers for Medicare and Medicaid Services in order to implement specific adjustments to the Medicare Equalization policy. The changes will be implemented to coincide with the effective date of the State Plan amendment. (Source: Texas Register, June 22, 2012)
State information on the adopted rules

Balancing Incentive Program

On September 4, 2012, CMS approved the state's BIP application, awarding $301.5 million of enhanced Medicaid funds.  Texas must implement the required structural changes and achieve a 50 percent benchmark of Medicaid community-based LTSS expenditures by October 2015.  HHSC has delegated coordination of BIP activities to DADS. (Source: State website)
BIP application (Submitted 6/29/2012)

Section 1915(i) State Plan Amendment

The state plans to cover Day Activity and Health Services (DAHS) under Section 1915(i) State plan HCBS benefit.  Target population include aged and disabled individuals living in the community, unless they qualify for nursing facility 1915(c) waiver services or are individuals with Intellectual Disabilities. For Year 1 (9/1/2012 – 8/31/2013), projected number of participants is 14,493 in STAR+PLUS (managed care) Service Areas, and 1,845 outside the managed care service areas.  In the STAR+PLUS Service Areas, the SMA conducts annual desk and on-site reviews of each contracted managed care organization (MCO). Outside the STAR+PLUS Service Areas, the Department of Aging and Disability Services (DADS) reviews a statistically valid randomly selected sample, proportionate to consumer enrollment in each long term services and support region.  All Day Activity and Health Services (DAHS) consumers are subject to random selection. (Source: State Plan Amendment (draft) According to a State Official, Texas withdrew the amendment in 2012 and has no plans at the current time to implement it.  (Source: State official)  

Vermont

Vermont Choice for Care—Section 1115 Demonstration Waiver

The Vermont long-term care section 1115 demonstration, known as “Choice for Care,” is a statewide initiative to rebalance long-term care services through managing nursing facility admissions and increasing community-based options.  The demonstration does not include children or individuals receiving institutional services through Intermediate Care Facilities for persons with Mental Retardation (ICF/MR). Choices for Care created an entitlement to Home and Community-Based Services (HCBS) for individuals with the highest need for services and also implemented a person-centered assessment and options counseling process to identify what services would be needed to enable individuals to remain in their own homes. The State also implemented the Program of All-inclusive Care for the Elderly (PACE) in two locations, one of which is rural. (Source: Medicaid.gov)
Fact Sheet

Current Approval Document (9/21/2010)

State Demonstration to Integrate Care for Dual Eligible Individuals

The demonstration includes full benefit dual eligibles, including those with intellectual/developmental disabilities. It will implement statewide under a capitated payment model starting January 1, 2014.  PACE Vermont participants (approximately 120 people) are not included. (Source: Demonstration Proposal)
State website on the demonstration

Health Homes

The Department of Vermont Health Access (DVHA) is submitting a Medicaid State Plan Amendment (SPA), effective 1/1/2013, to implement Health Home services pursuant to Section 2703 of the Affordable Care Act. Beneficiaries targeted are those with chronic opioid dependence, as defined by the DSM-IV-TR criteria for “Diagnosis of Opioid Dependence” and receiving Medication Assisted Therapy (MAT) for this condition. (Source: Draft State Plan Amendment)

Duals Demonstration

State Demonstration to Integrate Care for Dual Eligible Individuals is projected to cover full benefit Medicare-Medicaid enrollees (age 21 and older), older persons and persons with physical disabilities, nursing facility residents, and persons who receive services through the Elderly or Disabled with Consumer Direction (EDCD) Waiver.  Persons with intellectual/developmental disabilities who are not in the EDCD Waiver are excluded from the program.  Assisted living services, intellectual/developmental disability services, and PACE programs will be carved out.  The program will initially start in four regions in January 2014, with voluntary enrollment with opt out. (Source: CMS and Truven Health Analytics, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012)

Washington

Currently Operating Medicaid Managed LTSS Program

After inception in 2005, LTSS component was added to Washington Medicaid Integration Partnership (WMIP).  Under the program, primary, acute, behavioral, prescription drugs, and LTSS (nursing facilities and community-based services) are provided in capitated rate.  Groups enrolled include adults age 21-64 with SSI or SSI-related Medicaid and adults age 65 and older. Enrollment is voluntary, and very limited geographic area is covered. (Source: CMS and Truven Health Analytics, July 2012)
State Resource on WMIP (December 2010)

Duals Demonstration (Health Homes & Medicaid Managed LTSS) Approved (10/25/2012)

HealthPath Washington (formerly Pathways to Health): A Medicare & Medicaid Integration Project proposes to realign and integrate care through three strategies: 1. Health Homes (managed fee-for-service financial model); 2. Full Financial Integration Capitation (three-way capitation financial model); and 3. Modernized and Consolidated Service Delivery with Shared Outcomes and Aligned Financial Incentives (capitation and fee-for-service).  The project’s target population is full benefit Medicare-Medicaid enrollees of all ages. Strategy 1 Health Homes will implement statewide beginning January 2013. Strategy 2 will be available in certain counties beginning January 1, 2014.  Beneficiaries with developmental disabilities will be included in this model, but services in their 1915(c) waivers will be carved out of the capitation. Strategy 3 will be provided in counties where full capitation is not available beginning January 1, 2014.  It will include Medicaid services for individuals with I/DD through a fee-for-service model. (Source: Demonstration Proposal; NASDDDS Managed Care Tracking Report)

HealthPath Washington project website
HealthPath Washington Medicaid Health Homes Website
HealthPath Washington Medicaid Health Homes Presentation (6/21/2012)

Health and Human Services (HHS) announced (10/25/2012) that Washington State will be the second state to partner with the Centers for Medicare & Medicaid Services (CMS) to test a new initiative to improve health care for the State’s Medicare-Medicaid enrollees. Washington is also the first state to launch a managed-fee-for-service demonstration to better integrate and coordinate care delivery across primary, acute, behavioral health, prescription drug, and long-term supports and services, to better serve Medicare-Medicaid enrollees. (Source: Centers for Medicare and Medicaid Services)
Memorandum of Understanding

Strategy 1: Health Homes
Health Home services for all high-cost/high-risk dual eligible will be implemented statewide beginning January 2013. 
HealthPath Washington Medicaid Health Homes Website
HealthPath Washington Medicaid Health Homes Presentation (6/21/2012)

Strategy 2: Medicaid Managed LTSS

Full integration of mental substance abuse and long-term services and supports into managed care will begin in January 2014.  Older adults, adults with physical disabilities, and adults with intellectual/developmental disabilities are projected to be enrolled by January 2014, with voluntary enrollment with opt out.  Waiver services for persons with intellectual/developmental disabilities will be carved out. (Source: Duals Demonstration Proposal; CMS and Truven Health Analytics, July 2012)

Health Homes

The State implemented its Health Homes program for seniors and persons with disabilities on January 1, 2013 as a part of the State’s Medicare-Medicaid financial alignment initiative. The State describes health homes as special provider agreements that will offer improved care and coordination across all service domains for Medicaid patients with complex care needs. The Health Homes concept encourages integration of health care services, including primary care, mental health, chemical dependency and long-term care services. (Source: Washington State Health Homes News Release)
State Website on Health Homes

Health Homes

The West Virginia Bureau for Medical Services (BMS), the State Medicaid agency, plans to submit State Plan Amendment for Health Homes this year.  Draft of the State Plan Amendment is available here.  According to the draft, Health Home will be provided in limited geographic area in the State, starting January 1, 2013.  Eligibility will be limited to those individuals who have one condition and at risk for a second: 1. Bipolar disorder; 2. At risk for Hepatitis B and/or C. (Source: State Website)

Draft State Plan Amendment (8/24/2012)
State Website on Health Homes / West Virginia Health Improvement Institute Website on Health Homes
Guidance Letter from CMS

Wisconsin

Currently Operating Medicaid Managed LTSS Programs

The State has two MLTSS programs. Wisconsin Family Care (under 1915(b) and 1915(c)) provides LTSS to adults under age 65 with physical disabilities, adults under age 65 with intellectual/developmental disabilities, and adults of age 65 and older.  HCBS waiver services are only available to members who are a nursing home level of care, and primary, acute, and prescription drugs services are excluded from capitation rate. Enrollment is voluntary (choice of Family Care, Family Care Partnership, PACE, or IRIS depending on what is offered in the county and individual’s functional level of care) with opt in. The program covers 57 counties in the State (out of 72 counties). Effective April 3, 2012, temporary caps on enrollment in the Family Care or IRIS programs were lifted. More information on Family Care is available here and here. (Source: dhs.wisconsin.gov) 

Wisconsin Family Care Partnership (FC-P) (under 1932(a) and 1915(c)) provides Medicare cost-sharing, behavioral health (not covered by Medicare), prescription drugs (not covered by Medicare), LTSS (HCBS and institutional), and other services including case management, dental, hospital, hospice, and therapies.  Groups enrolled are adults under age 65 with physical disabilities, adults under age 65 with developmental disabilities, and frail adults of age 65 and older.  Enrollment is voluntary with opt in. The program covers 19 counties in the State (out of 72 counties). (Source: CMS and Truven Health Analytics, The Growth of Managed Long-Term Services and Supports (MLTSS) Programs: A 2012 Update, July 2012)
State Program Website
Waiver Application
NASUAD & n4a presentation

State Demonstration to Integrate Care for Dual Eligible Individuals

Wisconsin’s proposed demonstration, Virtual PACE, will include all people who are full dual eligible members over the age of 18 residing in a Nursing Home (NH) on a long-term basis and receiving Medicaid services via the fee-for-service system at the time of enrollment. On January 1, 2013, Wisconsin will implement Virtual PACE in the Southeastern region, and then statewide in 2015. The demonstration will use a capitated payment model. (Source: Demonstration Proposal)
State website on the demonstration

Section 1915(i) State Plan Amendment

Wisconsin's Medicaid State Plan Amendment (SPA) under 1915(i) State Plan Home and Community-Based Services is called Community Recovery Services, and provides three specific services – Community Living Supportive Services, Supported Employment, and Peer Supports – under the umbrella of psychosocial rehabilitation. Populations covered are elderly and disabled individuals. The SPA was approved June 3, 2010. (Source: Program website)

Health Homes

The State’s Health Homes State Plan Amendment received approval from CMS (10/1/2012). The service targets Medicaid and BadgerCare Plus members with a diagnosis of HIV/AIDS and who have at least one other diagnosed chronic condition or is at risk of developing another chronic condition. (Source:Approved Health Homes State Plan Amendment)