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State issues press release on dual eligibles

The Executive Office of Health and Human Services issued a press release on Thursday, August 23 regarding the dual eligibles initiative. Please read it below.

The Providers' Council will continue to monitor this development. Please contact Bill Yelenak with any questions.


Commonwealth of Massachusetts
Executive Office of Health and Human Services
Press Release
Contact: Dave Kibbe: 617-573-1612; Paulette Song: 617-573-1610


Massachusetts first state approved to launch integrated model to improve care and contain costs

BOSTON – Thursday, August 23, 2012 -- The Patrick-Murray Administration today announced that Massachusetts is the first state in the nation to receive approval from the Obama Administration to implement a health care initiative to improve care and contain cost for 111,000 persons with disabilities who are dual eligible for Medicaid and Medicare.

MassHealth signed a Memorandum of Understanding (MOU) with the federal Centers for Medicare and Medicaid Services (CMS) to implement the demonstration to provide integrated care for individuals who are eligible for both MassHealth and Medicare. Massachusetts is the first state working on similar demonstrations to sign an MOU with CMS.

“Massachusetts has been a national leader on expanding access to health care and controlling costs,” said Governor Deval Patrick. “By entering this agreement with the Obama Administration we continue to be a leader in providing integrated, high quality care for our residents with complex needs.”

The signing indicates CMS’s official approval of the Massachusetts demonstration, which will create a new option for approximately 111,000 dual eligible individuals between the ages of 21 and 64. Those who enroll in the demonstration will be able to receive both MassHealth and Medicare services plus additional behavioral health and community support services through health plans that promote the provision of integrated care.

"Thanks to this new model of care, our sickest patients can now focus on getting healthy rather than getting frustrated by a confusing or disjointed healthcare system, said Congressman Edward J. Markey (D-Malden), dean of the Massachusetts Congressional delegation. “Patients with several complex conditions can pose the greatest challenges for health care providers, and this agreement ensures that Massachusetts once again will lead the way in improving how this population of patients receives quality medical care. I applaud Governor Patrick and the Obama Administration for their leadership on this important issue."

"Massachusetts is once again serving as a pioneer in finding innovative ways to provide affordable, accessible health care to our residents,” said Congresswoman Niki Tsongas. “I look forward to working with both the Governor’s administration and the Department of Health and Human Services to ensure that this program helps expand the options available to individuals to meet their specific health care needs and provides better, more coordinated care to those who need it most."

“I’m proud that under Governor Patrick’s leadership Massachusetts has become the first state to implement this piece of the Affordable Care Act, which will enhance services and provide them in a more efficient manner to patients, while also improving the efficiency of the system overall,” said Congressman Barney Frank. “It is nice to have a Governor committed to building on Massachusetts’s role as the national leader in health care, rather than one whose main interest appears to be in repudiating it.”

"I commend the Patrick-Murray Administration for their constant efforts to improve healthcare options while controlling costs," said Congressman Jim McGovern. "Massachusetts is a national leader in ensuring that residents with complex needs get the high-quality care they deserve, and this first-in-the-nation announcement is a major step forward."

“With this agreement on dual eligibility and integrated care, Massachusetts continues to distinguish itself as a nationwide leader in controlling rising health costs and improving care quality,” said House Speaker Robert A. DeLeo. “This is yet another measure that will assist those who require health care in times of economic recession.”

“This agreement emphasizes improved access toward quality that reflects the unique needs of people with disabilities while acknowledging their independence and role in directing their care,” said Secretary of Health and Human Services Dr. JudyAnn Bigby. “This program will also decrease costs by providing better coordination of care.”

“One of the primary goals of our recent payment reform and cost containment law is to provide improved health quality through coordination of care,” said Senator Richard T. Moore, co-chairman of the Joint Committee on Health Care Financing. ”People with disabilities deserve the best care in the most cost-effective setting, and the new ICO model moves Massachusetts strongly in the right direction.”

"It is a credit to this Administration for once again being a leader in ensuring that our citizens with specialized needs have access to the best possible care,” said Representative Steven M. Walsh, co-chairman of the Joint Committee on Health Care Financing “This initiative will not only improve services for those enrolled in both MassHealth and Medicare, but will lower their health care costs through the coordination of these plans." 

In June, the Patrick-Murray Administration issued a Request for Responses to competitively select organizations to serve as Integrated Care Organizations (ICOs) in the demonstration. The selected ICOs will be accountable for providing MassHealth and Medicare benefits, additional coordinated behavioral health services, additional community support and independent living services. Following the selection process, the ICOs will enter into contracts with HHS and CMS, and will begin accepting enrollments in January 2013 for coverage effective April 1, 2013.

ICOs will receive a global payment from MassHealth and Medicare and will be accountable for the total care of each enrollee.  The global payment will afford ICOs significant flexibility to cover a range of community-based services, when recommended by the member’s care team, as a means to promote independent living and as an alternative to high-cost traditional services.

“This initiative will help test a new model for improving and simplifying health care for individuals enrolled in both Medicare and MassHealth,” said MassHealth Director Dr. Julian Harris. “Providers will have flexibility under this integrated system to consider an individual’s full needs and unique circumstances and to tailor a care plan to meet them.”

Under the demonstration, members will receive clear and accessible information from MassHealth and Medicare about their enrollment choices, and MassHealth will manage enrollments and disenrollments for the ICOs.  They have the option of maintaining their current providers and will have the ability to change ICOs or opt out of the demonstration at any time.

These measures, together with market innovations in integrated care, new cost-sharing models enabled by the federal Affordable Care Act and renegotiated contracts between some insurers and providers, have helped Massachusetts make significant progress in controlling health care costs. Governor Patrick recently worked with the Legislature to enact a cost-containment law that will give the industry more tools to continue moving toward the kind of integrated care that rewards the quality of care, not the quantity.

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