As Medicaid continues to grow under the Affordable Care Act, 2014 will become a transformative year for the federal-state health program, reported LifeHealthPro.
Given the inherent complexities associated with the Medicaid population and the huge growth of the program, insurers and states likely will increase their focus on providing behavioral health and coordinating care for dual-eligibles. These are two of five Medicaid trends that will continue in 2014, according to LifeHealthPro.
1. Providing behavioral health
Increasingly high costs and poor health outcomes will drive states and insurers to consider weeding out traditional care approaches, including managed care organizations, to instead implement programs like patient-centered medical homes and accountable care organizations. Colorado was one of the first states to launch an ACO model to rein in Medicaid costs while improving quality of care; now other states are following its lead, FierceHealthPayer previously reported.
When creating these programs, many Medicaid expansion states may turn to insurers to help them administer plans incorporating value-based reimbursements. Expansion states also will see a particular need to provide behavioral health to new Medicaid members, who often have an increased rate of mental health and substance abuse issues. States expanding Medicaid already have enrolled about 3 million people with serious mental illness, psychological distress or a substance abuse disorder into their Medicaid programs. Meanwhile, insurers providing Medicaid plans in the 26 expansion states will likely face new regulatory oversight aimed at ensuring parity compliance.
2. Coordinating care for dually eligible consumers
Although people who are eligible for both Medicaid and Medicare make up only 15 percent of all Medicaid members, they account for 40 percent of all Medicaid costs. Moreover, most dual-eligibles have more chronic conditions than the general Medicare population.
The Affordable Care Act aims to rein in costs associated with dual-eligibles by helping to enable care coordination among consumers enrolled in both Medicare and Medicaid programs. In particular, state demonstration projects to integrate care for dual-eligible individuals has garnered strong interest, with 26 states submitting proposals to participate. And more than 2 million Medicaid members are projected to enroll in dual demonstrations during the next three years.
To learn more:
- read the LifeHealthPro article