Early Insights From Ohio’s Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries
Issue Brief
Washington received approval for both capitated and managed FFS models but subsequently withdrew its capitated model.
Prior to the launch of MyCare Ohio, an estimated 115,000 individuals were eligible for the demonstration. Conversations with state officials in February 2015 reported that the total number of MyCare eligible individuals is closer to 96,000. Some of the differences between these estimates can be attributed to individuals being identified as having third-party health insurance, a factor that excludes them from participating it the demonstration.
For a list of MyCare Ohio notices to beneficiaries, enrollment reports, the MOU, and other related materials, see: http://www.healthtransformation.ohio.gov/CurrentInitiatives/IntegrateMedicareMedicaidbenefits.aspx and http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Ohio.html.
Kaiser Commission on Medicaid and the Uninsured and Urban Institute estimates based on data from FY 2011 MSIS and CMS 64 reports, 2015.
The five HCBS waivers included in the demonstration are: PASSPORT, Ohio Home Care, Assisted Living, Choices, and the Transitions Carve-out waiver.
For a description of the CareSource/Humana alliance see: http://press.humana.com/press-release/current-releases/caresource-humana-alliance-care-dual-eligible-population-ohio.
Henry J. Kaiser Family Foundation, State Health Facts Online, Total Medicaid MCO Enrollment, September 2014, available at: https://www.kff.org/other/state-indicator/total-medicaid-mco-enrollment.
Ohio Department of Medicaid, “MyCare Ohio: Annual Report on Integrated Care Delivery System Evaluation,” July 1, 2014, available at: http://medicaid.ohio.gov/Portals/0/For%20Ohioans/Programs/MyCareOhio/AnnualReport/MyCare-OhioAnnualReport-SFY2014.pdf.
Contract between United States Department of Health and Human Services Centers for Medicare & Medicaid Services in Partnership with the State of Ohio Department of Medicaid and MyCare Plans, issued February 11, 2014, available at: http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/OhioContract.pdf.
Ohio Department of Medicaid, “MyCare Ohio: Annual Report on Integrated Care Delivery System Evaluation,” July 1, 2014, available at: http://medicaid.ohio.gov/Portals/0/For%20Ohioans/Programs/MyCareOhio/AnnualReport/MyCare-OhioAnnualReport-SFY2014.pdf.
Savings percentages and quality withhold percentages will be applied based on demonstration years as follows: demonstration year one: May 1, 2014 – December 31, 2015; demonstration year two: January 1, 2016 – December 31, 2016; and demonstration year three: January 1, 2017 – December 31, 2017.
Contract between United States Department of Health and Human Services Centers for Medicare & Medicaid Services in Partnership with the State of Ohio Department of Medicaid and MyCare Plans, issued February 11, 2014, available at: http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/OhioContract.pdf.
Each MyCare Ohio plan uses a combination of predictive modeling software; health risk assessment tools; functional assessments; referrals from individuals, family members and providers; and administrative claims data to determine risk level. Additional information used to determine risk level includes medical, behavioral health (i.e. mental health and substance use), long-term services and supports, and social needs. All plans are currently using five stratification levels: intensive, high, medium, low and monitoring. For more information on risk stratification see: Center for Health Care Strategies, “Risk Stratification to Inform Care Management for Medicare-Medicaid Enrollees: State Strategies,” November 2014, available at: http://www.thescanfoundation.org/sites/thescanfoundation.org/files/inside_risk_stratification_10_30_14_final.pdf.
During the transition period, a change from a beneficiary’s existing services or provider can occur in any of the following circumstances: 1) beneficiary requests a change, 2) significant change in beneficiary’s status, 3) provider chooses to discontinue services to a beneficiary, and 4) provider performance issues are identified that affect a beneficiary’s health and welfare.
Appendix 5, Ohio’s Department of Medicaid Specific Eligibility Requirements for Enrollment in MyCare Ohio Plans, available at: http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/OHApp5.pdf.
Contract between United States Department of Health and Human Services Centers for Medicare & Medicaid Services in Partnership with the State of Ohio Department of Medicaid and MyCare Plans, issued February 11, 2014, available at: http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/OhioContract.pdf.
For a sample MyCare Ohio benefit change notice see: http://uhcanohio.org/sites/default/files/MyCare%20Ohio%20Benefits%20Change%20Notice.pdf.
Laura Summer and Jack Hoadley (in press), “Early Insights from Commonwealth Coordinated Care: Virginia’s Demonstration to Integrate Care and Align Financing for Dual Eligible Beneficiaries,” Georgetown University Health Policy Institute for the Kaiser Commission on Medicaid and the Uninsured, April 2015. Colleen Barry et al, “Early Insights from OneCare: Massachusetts’ Demonstration to Integrate Care and Align Financing For Dual Eligible Beneficiaries, Kaiser Commission on Medicaid and the Uninsured, April 2015, available at https://www.kff.org/medicaid/issue-brief/early-insights-from-one-care-massachusetts-demonstration-to-integrate-care-and-align-financing-for-dual-eligible-beneficiaries.
Ohio Department of Medicaid, “MyCare Ohio: Annual Report on Integrated Care Delivery System Evaluation,” July 1, 2014, available at: http://medicaid.ohio.gov/Portals/0/For%20Ohioans/Programs/MyCareOhio/AnnualReport/MyCare-OhioAnnualReport-SFY2014.pdf.
See MPR/KFF analysis of CMS Medicare Advantage enrollment and landscape files, Table A5, 2104, available at: https://www.kff.org/report-section/medicare-advantage-2014-spotlight-enrollment-market-update-overall-trends.
Ohio Department of Medicaid, “MyCare Ohio: Annual Report on Integrated Care Delivery System Evaluation,” July 1, 2014, available at: http://medicaid.ohio.gov/Portals/0/For%20Ohioans/Programs/MyCareOhio/AnnualReport/MyCare-OhioAnnualReport-SFY2014.pdf.
Roland Hornbostel,”MyCare Ohio: Design and Early Implementation,” State Budgeting Matters, Volume 10, Number 4, August 2014, available at: http://www.communitysolutions.com/assets/docs/
State_Budgeting_Matters/2014/sbmv10n4_mycare_hornbostel_082614_embed_updated.pdf.Contract between United States Department of Health and Human Services Centers for Medicare & Medicaid Services in Partnership with the State of Ohio Department of Medicaid and MyCare Plans, issued February 11, 2014, available at: http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialAlignmentInitiative/Downloads/OhioContract.pdf.
Ohio is one of thirteen states (plus DC) that currently provide state level authority and/or resources to support the expansion of the ombudsman program to serve individuals living in non-facility settings. See: 80 Fed. Reg. 7706 (February 11, 2015), available at: http://www.gpo.gov/fdsys/pkg/FR-2015-02-11/pdf/2015-01914.pdf.
John Arnold, “Taking the Pulse of MyCare Ohio,” http://uhcanohio.org/blog/takingthepulseofmycareohio, October 7, 2014, and http://uhcanohio.org/blog/MyCareOhioConsumerCallSomeImprovementsContinuedProblems, November 5, 2014.