Gov. Terry McAuliffe today announced the launch of Commonwealth Coordinated Care (CCC), a program that will blend and coordinate Medicare and Medicaid benefits for approximately 78,000 eligible Virginians. As only the third state to implement this type of coordinated care for Medicare-Medicaid enrollees, Virginia has pioneered an innovative, responsive program to provide health care and long-term services and supports to people who often have very complex needs.
CCC is Virginia’s response to years of national research that shows the current structure of the two separate health programs results in cost inefficiency and poor health outcomes due to uncoordinated care. Governor McAuliffe said “Nationwide, individuals who are dually eligible for Medicare and Medicaid typically have the highest and most complex medical needs but are often underserved by the misaligned rules and financial incentives of the two separate programs. CCC will blend all of the benefits currently provided under Medicare and Medicaid into one plan with a designated care manager who will ensure person-centered and efficient health care services are provided. This will not only make it easier to manage the system from the beneficiary’s perspective, this innovative program will bring greater efficiencies and cost savings to the state’s overall healthcare delivery system.”
The development of Commonwealth Coordinated Care began in 2011 when the Virginia General Assembly directed the Virginia Department of Medical Assistance Services (DMAS) to develop a program that would better meet the needs of Virginians receiving both Medicare and Medicaid benefits. Achievement of this program represents a major reform to Medicaid in Virginia, signifying the readiness of Virginia’s healthcare system to take the next step and accept federal funds to close the coverage gap.
Speaking about the accomplishment, Governor McAuliffe stated, “Now we must continue to improve our healthcare system by bringing $2 billion of taxpayer funds per year back to the Commonwealth to cover hundreds of thousands of Virginians. Every day that we wait, we forego over $5 million in taxpayer funds that could be used towards ensuring that more of our friends and neighbors have access to the quality healthcare they deserve.”
Three Medicare-Medicaid health plans, Anthem Healthkeepers, Humana, and Virginia Premier have contracted with the Centers for Medicare and Medicaid Services (CMS) and DMAS to provide services under CCC for the four-year demonstration. The contract commits the parties to a new model of care for Medicare/Medicaid beneficiaries that will provide efficiencies and improve the delivery of services to some of the Commonwealth’s most vulnerable citizens. The contract includes provisions for person-centered care planning, interdisciplinary care teams, care coordination services, provider credentialing, access to services, unified appeals and grievances, and closely monitored quality of services.
Virginians presently eligible for CCC include those who are full Medicare and Medicaid beneficiaries (meaning entitled to benefits under Part A and enrolled under Medicare Parts B and D, and receiving full Medicaid benefits), are aged 21 or older, and live in designated regions around the Commonwealth. For the first time in Virginia, individuals receiving long-term supports and services through nursing facilities and the Elderly Disabled and Consumer Direction (EDCD) Waiver will also be eligible to participate in a managed care program through CCC.
Secretary of Health and Human Resources, William A. Hazel, Jr., MD, said “CCC will offer enrollees the opportunity to combine all of their existing Medicare and Medicaid benefits into one plan. That one plan will go beyond the Medicaid and Medicare benefits and provide a care manager from the health plan who will complete a comprehensive evaluation to understand the enrollee’s situation and work directly with the enrollee to develop a plan of care that is tailored to their needs and preferences.” In addition, plans will offer supplemental benefits that are currently not available in the Medicaid or Medicare programs.
Eligible individuals will receive letters in the coming weeks notifying them of their eligibility for CCC and providing information on how to enroll in the program. Letters will include comparison charts of the three health plans and contact information to speak with a trained enrollment representative. The Virginia Insurance Counseling Assistance Program (VICAP) can provide information and insurance counseling for beneficiaries seeking additional education and support with CCC enrollment. In the demonstration phase, CCC is available to Virginians in five regions of the Commonwealth: Tidewater, Central, Northern Virginia, Charlottesville, and Roanoke.
For a full list of localities you may visithttp://www.dmas.virginia.gov/