Virginia's costly Medicaid program is being combined for some of its most service-intensive clients. The Department of Medical Assistance Services says it is testing whether combining and simplifying the process for those who receive both Medicaid and Medicare can help lower the costs.
Some estimates indicate that one-third of Medicaid patients who need the most care comprise more than two-thirds of the cost of the program.
Their services are provided with a mixture of Medicaid and Medicare funds. As Karen Kimsey with DMAS explains, Medicare doesn't cover many services, so where it falls short, Medicaid steps in. But it's confusing and redundant for the dual enrollee who must navigate through all of the benefit packages and providers.
However, because Virginia is a managed-care state, it has an opportunity to create one entity to coordinate all services.
"It's a Commonwealth Common Care program to try and help people understand that this program is for us to work with them, and coordinate these two program benefits," says Kimsey. "It's a three-year demonstration that begins in January."
Virginia is one of six states enrolled in the demonstration. It targets specific regions and as a result, only 78,000 of the 100,000 dual enrollees can benefit from it.