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OLYMPIA -- The Department of Social and Health Services (DSHS) will conclude a voluntary managed-care pilot project in King and Pierce counties that tested the integration of Medicare and Medicaid services for about a thousand clients who are eligible for both programs.
The project is ending, effective June 30, although the goal is to complete the transition of clients to their original programs by April 30, according to Doug Porter, Assistant DSHS Secretary for the Health and Recovery Services Administration, and Kathy Leitch, Assistant Secretary for the Aging and Disability Services Administration. Staff from both administrations worked together on the pilot.
The agency and Evercare, its managed care vendor on the project, began notifying clients about the transition this month.
Clients who participated in the program will continue to have Medicaid coverage in this transition. The transition also will not affect the clients' Medicare benefits, and Medicare and Medicaid Integration Project (MMIP) clients enrolled in Evercare's Medicare Advantage Special Needs plans will stay enrolled in Evercare's Medicare plan.
Porter, who heads the state's Medicaid program, said DSHS and Evercare's care managers would help clients transition back to fee-for-service providers.
Leitch said representatives from the appropriate Area Agencies on Aging, Evercare, the DSHS Home and Community Services Office, and other DSHS staff would all be in contact with clients during the transition.
"The basic difference for clients will be that their Medicaid health-care and long-term care providers will be paid directly by DSHS, not by contract with Evercare," she said. "There is no additional cost for clients – they will pay the same share of any costs as before."
"We will be able to apply the lessons we learned from the three-year pilot in our clients' new fee-for-service care setting as well as future pilots aimed at refining this and other approaches to improving patient care," Leitch said.
Medicaid is a state-federal program that provides primarily medical assistance and long-term care to low-income populations, while Medicare is a federal medical assistance program open to most U.S. residents when they are 65.
The pilot project – called "Medicare and Medicaid Integration Project," or MMIP -- was an attempt to bring together Medicaid- and Medicare-funded services in a coordinated model that addressed the medical, social and long-term care needs of seniors. DSHS and Evercare are working together to develop a new delivery model option that builds on the best practices of MMIP, leverages Evercare's clinical and chronic care management expertise, and builds upon the infrastructure and successes of Washington's long-term care system.
The managed care was provided with the help of Evercare, one of the nation's largest health care plans dedicated to providing services and care management innovations for people who have long term or advanced illness, are older or have disabilities. Clients were selected for the pilot from among seniors who were already enrolled in Evercare Medicare Advantage Special Needs Plans.
MMIP was one of several integration projects that DSHS has operated in the past few years to see how service deliveries and efficiencies can be improved. Other projects have included:
MMIP clients who want to disenroll from the project before April 1 may do so. For more information, clients or family members can call DSHS at 1-800-562-3022 or Evercare at 1-877-702-5110.
FOR ADDITIONAL BACKGROUND, CONTACT: Kathleen Harrington, Evercare Media Relations, 952-936-6946
Alice Lind, Chief, Office of Care Coordination, DHS, HRSA, DSHS 360-725-1629
Kathy Spears, Media Relations, DSHS, 360-902-7893
Jim Stevenson, Communications Director, HRSA, DSHS, 360-902-7604 (Pager: 360-971-4067).
