California on Wednesday became the fifth state—and by far the largest—to win approval of a CMS demonstration project that will put beneficiaries dually eligible for Medicare and Medicaid into managed-care plans.
The CMS drew heavy criticism last year for the scope and pace of the Financial Alignment Initiative, which stems for the Patient Protection and Affordable Care Act and seeks to find a way to rein in costs for a disproportionately expensive population of patients.
Dual eligibles are among the highest-cost users of healthcare services in California's Medicaid program, Medi-Cal, accounting for 25% of its spending, according to DHCS.
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Source: Modern Healthcare
The agreement between the California Department of Health Care Services and the CMS (PDF) will provide a single, capitated monthly payment for providing services for about 456,000 dual-eligible enrollees, beginning in October. While that figure is significant, it is about half as much as Democratic Gov. Jerry Brown requested in early 2012.