Oral

Over the course of the last eighteen months, CMS has been preparing to launch the first integrated care and financing strategies for younger dually eligible Medicaid/Medicare beneficiaries. Under ACA-related demonstration authority, 15 planning grant states and 22 others have requested the opportunity to integrate care and financing for this complex set of almost 4M under-65 year old individuals with disabilities; they include some of the most expensive Medicaid and Medicare recipients. While integrated Medicaid/Medicare options have been available for seniors for over a decade, the same opportunities for better financial alignment and care management has not been available to the younger dual population, in spite of the extensive demonstrated need for improved care delivery, coordination, and cost efficiencies. Recognizing the complexity of the populations and the process, CMS - and the involved states - have prioritized a very public, engaged process across consumer, advocate, provider, and plan representatives. Similarly, CMS and external partners have been accelerating the availability of population, expenditure, legal and other analytics to support this effort. The proposed panel of national federal agency, academic, and advocacy representatives has been involved in national and state-level dual planning and brings historic and current expertise regarding the challenges - and the opportunities - of this endeavor. Their analyses will provide useful best practice and critical perspectives regarding emerging legal, administrative, risk adjustment, risk management, primary care transformation, and consumer protection strategies being mounted in the proposed demonstrations. Additionally they will focus particular attention on the important contributions of planned behavioral health, long-term supports, and primary care integration efforts. There is much at stake in this enterprise and the complexity and speed of the process have been straining the local and national capacity to respond. This panel offers the opportunity for conference attendees working in the arenas of disability and aging, care management, integration, and financing, and public and private program administration to get a substantive update on the demonstrations as implementation rolls out in states. The duals endeavor will be an important platform for future Medicaid & Medicare development for people with disabilities across the lifespan; its success is critical.

Session Objectives: Identify relevant characteristics of the dually eligible younger disabled population. Discuss the objectives of the CMS duals demonstration. Explain the overall profile of state-based proposals. Discuss critical opportunities and challenges facing beneficiaries, providers, plans and states in the implementation of this ACA-related initiative.

CE Credits: Medical (CME), Health Education (CHES), Nursing (CNE), Public Health (CPH) , Masters Certified Health Education Specialist (MCHES)