New ACAP Fact Sheet: Stars Quality Rating System for Medicare Plans Should Take Special Needs of Dual Eligibles Into Account

A new ACAP fact sheet finds that the Medicare Stars quality rating system for health plans participating in the Medicare Advantage program does not adequately account for the special needs of Medicare beneficiaries who are dually eligible for both the Medicare and Medicaid programs.

The report draws upon an analysis of quality data from Medicare Advantage plans performed by Ingenix Consulting, which has since been renamed OptumInsight. The analysis found that plans serving dual eligibles, or Dual Eligible Special Needs Plans (D-SNP), are administered as effectively as plans that do not serve dual eligibles, but post lower clinical quality scores as a result of the underlying health conditions of the populations they serve. This could result in an unintended disincentive for plans to enter or maintain their presence in the D-SNP market, which could threaten the quality of care offered to dual eligibles.

“Congress and two administrations have repeatedly acknowledged the distinct needs of dual eligibles through the structure of the Medicare Advantage program and through regulatory oversight, especially around quality reporting requirements. But those distinctions aren’t made in the Stars quality ratings,” said ACAP CEO Margaret A. Murray. “Comparing plans on quality and paying bonuses for performance is the right idea – but the comparisons need to be apples-to-apples or else the system doesn’t work.”

ACAP Marks Second Anniversary of Health Reform, Weighs In on Medicaid Expansion Question Before the Supreme Court

ACAP observed the second anniversary of enactment of the Affordable Care Act with a brief summary of some of the benefits the law has already had on Americans with low incomes, young adults, and state budgets. In a statement, ACAP CEO Meg Murray noted that two years ago, "The status quo was not an option... nor is a return to it an option now. A lot of work remains to implement health reform and ensure that its results are in line with its potential. Challenging questions around the details of health reform persist. Safety Net Health Plans are committed to doing their share to help answer these questions and to assure that the Affordable Care Act continues to realize the tremendous promise it has for all of us.”

In a separate statement issued the day before the Supreme Court would take up the question of whether the expansion of Medicaid under the Affordable Care Act is constitutional, Murray noted that ACAP had signed on to an amicus brief in the case, noting, "We believe... [the expansion] is will within the parameters of the existing relationship between the Federal government and the states with respect to the Medicaid program--and other Federal programs that range from infrastructure to education. Accordingly, we are confident that the Court will ultimately uphold the expansion of Medicaid once the dust clears."

Links to both statements follow: Health reform | Medicaid expansion

ACAP-Commissioned Paper Proposes New Model of Care, Financing for Dually Eligible Beneficiaries

A new paper commissioned by ACAP and written by researchers from the George Washington University School of Public Health & Health Services outlines a new proposal for providing care to individuals eligible for both Medicare and Medicaid, or “dual eligibles.”

The paper, by Jane Hyatt Thorpe, J.D. and Katherine Jett Hayes, J.D., of George Washington University outlines a new state plan option where states would choose qualified health plans to provide highly integrated care services for dual eligibles under a framework of beneficiary protections and standards for financial integrity set by the Federal government.

The new state plan option, which ACAP has dubbed the Very Integrated Program (VIP), would be a distinct, permanent program featuring a fully-integrated, capitated model of care that can be chosen by states through a permanent choice within the Medicaid State Plan. States would contract with managed care organizations (MCOs) to provide care for dual eligibles, while CMS would set standards for strong patient protections covering areas including participant rights, eligibility, application procedures, administrative requirements, services, payment, quality assurance, and marketing guidelines. 

Read the proposal | Executive summary | Press Release | Slides

Safety Net Health Plans Ready Provider Networks for 2014 Expansion of Medicaid Eligibility: Results From an ACAP Survey

A new ACAP fact sheet assesses the efforts of Safety Net Health Plans to maintain strong provider networks as their enrollments are set to rise as Medicaid expands its eligibility criteria in 2014 under the Affordable Care Act.

While the Affordable Care Act extends eligibility for Medicaid coverage for individuals with income up to 133 percent of the federal poverty level in 2014, Safety Net Health Plans serving these populations must have networks of sufficient primary care and specialty providers to deliver needed care to expanded membership.

New Report: The Basic Health Program Could Dramatically Lower Premiums, Out-of-Pocket Costs for People with Low Incomes, Reduce Uninsured by 600,000

A new report from the Urban Institute commissioned by ACAP suggests that the Basic Health Program (BHP), an option for states created by the Affordable Care Act that would provide coverage to low-income Americans, could make health care more affordable for more than 5 million Americans and reduce the ranks of the uninsured by an additional 600,000 if this little-known feature of health reform were to be implemented by all states.

Under BHP, states could provide health coverage to people with incomes up to 200 percent of the federal poverty level who do not qualify for coverage through Medicare, Medicaid or the Children’s Health Insurance Program (CHIP). The state would contract with health plans or providers to provide coverage in lieu of offering them subsidized coverage through health insurance Exchanges. States implementing BHP would receive 95 percent of their estimated tax credits and subsidies for the Exchange from the Federal government.

Read: Full report (PDF) | Presentation | Audio Recording | Press statement

Once Again, Five of the Nation's Top Ten Medicaid Plans Are Safety Net Health Plans

Rankings from the National Committee for Quality Assurance, a leading independent health care quality organization, has shown that for the second consecutive year, ACAP-member Safety Net Health Plans make up half of the top ten Medicaid plans in the country. Read ACAP's press release, or see the full rankings.