AIS Newsletter Examines Challenges to Medicare-Medicaid Duals Demos in Certain States

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All 13 states participating in CMS’s duals demo have declared their intent to continue their participation in the program, a CMS official tells Atlantic Information Services in the Oct. 29, 2015, issue of Medicare Advantage News, although the fate of the program in a few states is uncertain.

All 13 states participating in the Medicare-Medicaid dual eligibles demonstration have indicated that they plan to continue in the program under the terms of the two-year extension offered by the Centers for Medicare & Medicaid Services, a CMS official tells Atlantic Information Services, Inc.’s (AIS) Medicare Advantage News (MAN). But, as CMS Medicare-Medicaid Coordination Office Director Tim Engelhardt points out, the letters are nonbinding and the fate of the demo program in a few states is uncertain. MAN examines the situation in those states in its Oct. 29, 2015, issue:

  • Texas asked for a host of changes in its extension-request letter, some of which are “things we need to do,” Engelhardt says.
  • Under state law, according to MAN, California must give notice by the beginning of 2016 that it will pull out of the demo in 2017, unless state officials can show the demo has met its projections for cost savings, with the data that will determine that decision scheduled to be released next month.
  • In a memo to stakeholders sent after the state sent in its extension acceptance letter, according to MAN, Virginia’s Department of Medical Assistance Services referred in two places to its CMS-backed duals demo ending in December 2017, which will cease to enroll new participants in June of that year.
  • New York’s long-term-care-focused duals demo continues to have issues attracting enrollees and seeks to make changes in its care management systems as part of its extension. Data from AIS’s Medicare-Medicaid Dual Eligibles Database indicate that the demo has enrolled only 9,942 duals since January out of about 170,000 eligibles. Another big hurdle has been the large volume of opt-outs, Engelhardt says, adding that the demo there needs “more provider engagement and buy-in.”

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About Medicare Advantage News
Medicare Advantage News is the health care industry’s #1 source of timely news and business strategies about Medicare Advantage plans, product design, marketing, enrollment, market expansions, CMS audits, and countless federal initiatives in this hotly contested area of health insurance. Published biweekly since 1994 (when it was Medicare+Choice), the newsletter exists to help plans boost revenues, increase enrollees, cut costs and improve outcomes in Medicare Advantage and Medicaid managed care. Visit for more information.

About AIS    
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at

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Jill Brown, Executive Editor
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Atlantic Information Services, Inc.

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