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ACAP Praises Proposed Changes to Risk Adjustment for Dual Eligibles

ACAP submitted a comment letter to CMS that details the support of Safety Net Health Plans for proposed changes to the risk adjustment system for health plans serving people who are dually eligible for Medicare and Medicaid.  In an October 28 memo, CMS came to the conclusion that the Medicare Advantage (MA) risk-adjustment system under-predicts the costs of full-benefit dual eligibles, or people who qualify for full Medicaid benefits due to their low incomes and their health status.

“For years, plans that have primarily served the most challenging dual-eligible populations have been operating at a competitive disadvantage,” said ACAP CEO Margaret A. Murray. “We believe the changes proposed by CMS will improve the accuracy of payments to plans serving full-benefit dual eligibles and we support them fully; CMS should implement these changes as soon as possible for both Dual-Eligible Special Needs Plans and Medicare-Medicaid Plans.”

Press Release | Full Letter

New Working Paper Examines Levels of "Churn" in Medicaid, Finding Little Improvement Over a Six-Year Period

A new working paper developed by researchers at George Washington University finds that the average person enrolled in Medicaid receives benefits, on average, for just 9.7 months of the year. This discontinuity in care owes itself largely to “churn,” where beneficiaries are disenrolled and reenrolled in the program owing to paperwork issues or small and often temporary changes in income, despite their underlying eligibility remaining unchanged.  This cycle of enrollment and disenrollment leads to poorer health, results in higher-cost episodes of care, and frustrates the efforts of providers and others to deliver top-quality health care.

Press Release | Full Report |

New Report Shows How Medicaid Programs Realize Savings Through Managed Care 

ACAP issued a new report that examined projected savings of capitation in the Medicaid program. The report, authored by The Menges Group, pegged overall savings to Medicaid programs owing to capitation at $2.1 billion in 2011, and projected that these savings would increase to $6.4 billion in calendar year 2016. Much of these savings could be attributed to an increasing prevalence of contracting with Medicaid managed care organizations among states in the intervening years, as well as an overall increase in the number of lives covered by Medicaid owing to its expansion under the provisions of the Affordable Care Act.

Full Report | Press Release | Infographic

ACAP Celebrates 50 Years of Medicaid

In a statement, ACAP CEO Margaret A. Murray commemorated the fiftieth anniversary of the signing of the Social Security Amendments of 1965, which provided Federal authorization for the Medicaid program. 

“Medicaid has been a lifeline for millions of individuals and families across the United States. It’s played a critical role in helping people lead healthier, happier and more productive lives. And it’s touched far more lives than people realize: nearly 2 of every 3 Americans have either benefited from Medicaid, or know someone who has.”

Full statement > 

ACAP Statement on S.2104, the Protecting Medicare Advantage for All Medicare Beneficiaries Act

ACAP Reacts to CMS Research on Link Between Socioeconomic Status, Performance on Medicare Advantage Quality Ratings

ACAP recently reacted to recent study conducted by RAND Corporation researchers on behalf of CMS examining the effects of socioeconomic factors on Medicare Advance Star rating performance. The study found that dual-eligible status was associated with lower scores on 12 of 16 measures studied, or 75 percent. Disability was associated with lower scores on 11 of 16 measures, or 69 percent.

“CMS’ research shows a clear disparity in quality scores for people with low incomes or disabilities," said ACAP CEO Meg Murray. "This is consistent with our plans’ experience. Accordingly,we sustain our call for CMS to implement changes to the Star rating system to adjust for this disparity.” Statement >

Related: ACAP Applauds Steps to Consider Full-Benefit, Partial Benefit Duals Separately
Related: Fact Sheet on Progress in Duals Demonstration Programs

Inside the ACAP Collaborative to Combat Rx Drug Abuse

A new ACAP report highlights innovative strategies employed by not-for-profit Safety Net Health Plans to address the issue of prescription drug abuse—in particular, the misuse and abuse of prescription opioid painkillers. The report draws upon the experience of ACAP’s Reducing Prescription Drug Abuse Collaborative, a group of 13 ACAP-member Safety Net Health Plans which designed and executed projects aimed at curbing prescription drug abuse among their plan members. 

Read the report >