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Integrating Medicare and Medicaid:
Some History and Where We’re Going
Moderator: Jenny Sand, Home Care by Black Stone
Panel:
Michael Cebellos, Buckeye Health Plan
Jan Reed, Molina Healthcare
Jana Snyder – Provider Services, Molina Healthcare
Deb Jacobs – Health Care Services, Molina Healthcare
Elbony McIntyre – Ohio Department of Medicaid
Ohio HFMA Winter Seminar – Friday, December 12, 2014
High-Level History
1965 –
Medicare &
Medicaid
created
2003 – MMA
and Part D
1970’s – HMOs
offer Medicare
2013 –
MedicareMedicaid Plan
demonstrations
Medicare-Medicaid plans are the first major attempt to modify the
existing system since inception.
2
Duals Enrollment & Spending
Current spending is unsustainable – change is here to stay.
Let’s make MyCare Ohio the best it can be.
3
Health Care System Choices
4
Demonstration States
5
The Opportunity
 Ohio was the third state to go-live with the demonstration, and
the only to begin with Medicaid passive enrollment.
 82 various metrics captured and evaluated by CMS.
 What success looks like to be determined through the various
state-based demonstration.
 We are five months into a 42-month demonstration.
 We are creating the future, together.
6
MyCare: Ohio’s Medicare/Medicaid Plan
 The Demonstration coordinates the physical, behavioral, and longterm care services for individuals over the age of 18 who are
eligible for both Medicaid and Medicare. This includes people with
disabilities, older adults and individuals who receive behavioral
health services
 The 42-Month Demonstration, went live in the Northeast region on
May 1, 2014. July 1, 2014 saw the last regions go-live.
 Of the roughly 182,000 Ohioans covered by both Medicare and
Medicaid, as many as 114,000 individuals are expected to be
served through the demonstration.
 MyCare Ohio enrollees, all of which have Medicaid, will be
passively enrolled into Medicare on January 1, 2015; unless a
member has chosen to opt-out.
8
Mission
The demonstration is a fully capitated program that creates
organized systems of care that provide comprehensive services to
Medicare-Medicaid enrollees. MyCare Ohio integrates and
coordinates healthcare delivery by:
 Utilizing managed care to improve care coordination that is
patient-centered
 Providing one point of contact for beneficiaries
 Emphasizing individual choice and control in care delivery
 Providing coordination of long-term care services, behavioral
health services and physical health services
 Supporting an individual’s right to live independently
 Reducing the overall cost of care for the beneficiary, Medicaid and
Medicare
 Providing a seamless transition between settings and programs.
9
Complexity to Simplicity
Medicaid
Behavioral
Health
Long-Term
Supports &
Services
Medicare
Part A & B
Medicare
Part D
10
MyCare
Ohio
Model of Care –
one point of entry
into a complex,
priority
competing
system
Model of Care
11
Model of Care
Accountable Point of
Contact
• One point of entry into complicated system
• Trans-disciplinary team facilitator
Assessment and Care
Plan
• Every member conducts a bio-psycho-social
assessments
• Integrated care plan and goals
Care Transitions
• Care Manager meet with member in-patient
• Trans-disciplinary team executes discharge
plan
Clinical Programs
12
• Medicare, Medicaid and assessment
information to stratify members into
appropriate clinical programs
Implementation Timeline
 January 1, 2015 – Medicare passive enrollment
 December 31, 2017 – Demonstration ends
Regions
Managed Care
Plans
Region
Northwest
9,884
•
•
Aetna
Buckeye
Southwest
19,456
•
•
Aetna
Molina
West Central
12,381
•
•
Buckeye
Molina
Central
6,029
•
•
Aetna
Molina
East Central
16,225
•
•
CareSource
UHC
Northeast Central
9,284
•
•
CareSource
UHC
Northeast
37,712
•
•
•
Buckeye
CareSource
UHC
Panel Questions & Answers