Administration for Community Living

1. Administration for Community Living Integrated Care Options for Medicare and Medicaid Dual Eligibles Kelly Cronin Deputy Administrator Center for Innovation and Partnerships July 24, 2019

2. Moving to a Person Centeredand Integrated System of Care To achieve a person centered system we need a person centered culture and approach at all levels – • Person centered planning and counseling • Person centered providers • Person centered systems that integrate and coordinate social service and health care delivery All SHIP counselors can embrace a person centered approach to counseling and problem solving • Training can ensure that these practices are used routinely with beneficiaries

3. CMS Strategic Priority – Integrated Care for Dual Eligibles • “Less than 10% of the 12 million dually eligible individuals are enrolled in any form of care that integrates Medicare and Medicaid services, and instead have to navigate disconnected delivery and payment systems.  This lack of coordination can lead to fragmented care for individuals, misaligned incentives for payers and providers, and administrative inefficiencies and burdens for all. We must do better, and CMS is taking action.” • Seema Varma, CMS Administrator https://www.healthaffairs.org/do/10.1377/hblog20190423.701475/full/

4. Integrated Care Options • Programs of All-Inclusive Care for the Elderly • Serve 45,000 beneficiaries across 110 programs in 31 states • Final rule updated the program published May 2019 • Open to Medicare benes and Medicare and Medicaid dual eligibles • State Integrated Care Models for Dual Eligibles – 3 options • 10 States in Financial Alignment Demo, could expand • Managed FFS model • New integrated care models proposed by state • MA Special Needs Plans • 2.9 million Medicare beneficiaries enrolled in institutional, chronic illness and duals SNPs • ACOs • 10.9 million Medicare beneficiaries in 518 ACOs

5. SMP/SHIP Meeting July 24, 2019 New Tools To Learn AboutIntegrated Care for Medicare + Medicaid Beneficiaries Gretchen E. Alkema, Ph.D. Vice President, Policy and Communications

6. Medicare + Medicaid Beneficiary Snapshot • 12 million Americans • 40% are under age 65 • Panoply of diversity 6

7. …And Have Complex Care Needs… • High rates of chronic illness, daily living/ functional needs, and social risk factors • 41% with mental health diagnosis • 17% rate health status as “poor” • Required to navigate two complex delivery, financing, and grievance/appeals systems Source: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/MMCO_Factsheet.pdf 7

8. … And Enrolled in Traditional Medicare As Well As Managed Care Share of Medicare Beneficiaries with Functional Impairment Source: Anne Tumlinson Innovationsanalysis of the 2015 Medicare Current Beneficiary Survey. Data is limited to Medicare beneficiaries living in the community and excludes long-stay nursing home residents. Functional impairment in this display is measured at the “moderate” level.

9. What’s Covered? 9

10. www.BetterCarePlaybook.com 10

11. The Challenge • Californians with • Medicare + Medi-Cal • are largely unaware of • their local options: • Program of All-Inclusive Care for the Elderly • Cal MediConnect • Fully Integrated Dual Eligible Special Needs Plan • Special Needs Plan • Medicare Advantage • Accountable Care Organization

12. The Research Most plan finder resources focus on Medicare-covered medical care & pharmacy access & costs None address daily needs or how to make the most of Medicare + Medi-Cal coverage

14. What Is MyCareMyChoice.org? New website to help Californians with Medicare + Medi-Cal locate and better understand their health coverage options what

15. Who Is It For? Californians who have Medicare + Medi-Cal Advisors of people with Medicare + Medi-Cal • Family caregivers • Consumer advocacy organizations • Community-based organizations • Enrollment advocates and brokers • Hospital discharge planners and social workers • Medical, social service, and other providers who

16. How Does It Work? Answer a few questions: • ZIP code • Age • Care needs and preferences Get personalized results that give: • A list of localized, “best fit” health coverage options • Contact information for each coverage option • Information and tools to take the next step how

17. Initial Question MCMC IN ACTION

18. Care Needs and Preferences MCMC IN ACTION

19. Personalized Results Results Page MCMC IN ACTION

20. Personalized Results Care ChoiceExample MCMC IN ACTION

21. When to Use It? People with Medicare + Medi-Cal can change health coverage: • Throughout the year • When newly eligible for Medicare + Medi-Cal • During Medicare Open Enrollment • October 15th to December 7th • Many beneficiaries review and change their health coverage during this time when

22. Advisor Tools Dedicated page for professionals, caregivers and family members who help people with Medicare + Medi-Cal coverage choices MCMC IN ACTION

23. Get Help! List of organizations who help and advocate for people with Medicare + Medi-Cal MCMC IN ACTION

24. What Languages Are Available? languages English MyCareMyChoice.org Spanish MiSaludMiDecision.org Traditional Chinese MyCareMyChoice.org/zh-tw Simplified Chinese MyCareMyChoice.org/zh-cn

25. Sign up for email alerts at www.TheSCANFoundation.org • Follow us on Twitter • @TheSCANFndtn • Find us on Facebook • The SCAN Foundation Our Vision: A society where older adults can access health and supportive services of their choosing to meet their needs. Our Mission: To advance a coordinated and easily navigated system of high-quality services for older adults that preserve dignity and independence. 25