An Analysis of the Universal Home Care Program: Considerations for Implementation with the Context of Maine\u27s Existing LTSS Programs

A citizen initiative on the November 2018 ballot (Question 1, An Act to Establish Universal Home Care for Seniors and Persons with Disabilities) would establish a Universal Home Care Program (UHC Program) to serve older adults and persons with a disability living in Maine. This report does not constitute either support for or opposition to the referendum but is intended as an independent assessment of how the UHC Program could be implemented if it were to be approved by Maine voters. This analysis focuses on the implications of the UHC Program within the context of the Medicaid and state-funded long term services and supports programs currently administered by the Maine Department of Health and Human Services. The analysis assumes implementation would be guided by three goals: 1) avoiding an unintended negative impact on existing programs, 2) optimizing the use of public resources, and 3) advancing a community first model of care that promotes living at home when appropriate and preferred. This report does not address the financing or governance of the UHC Program as those are defined under the proposed legislation

Financial Alignment Initiative New York FIDA Combined Second and Third Evaluation Report

The Medicare-Medicaid Coordination Office and the Innovation Center at the Centers for Medicare & Medicaid Services (CMS) have created the Medicare-Medicaid Financial Alignment Initiative (FAI) to test, in partnerships with States, integrated care models for Medicare-Medicaid enrollees. New York and CMS launched the Fully Integrated Duals Advantage (FIDA) demonstration on January 1, 2015, to integrate care for Medicare-Medicaid beneficiaries in the greater New York City area. The demonstration ended on December 31, 2019. Initially, twent-yone Medicare-Medicaid Plans (MMPs) participated in the demonstration. In the final year, six MMPs remained. MMPs received capitated payments from CMS and the State to finance all Medicare and Medicaid services. Stakeholders supported the demonstration’s elements of streamlined care planning and service authorization processes, and its integrated appeals process allowing a single path to appeal both Medicare and Medicaid service decisions. However, due to a combination of design choices, environmental factors, and early implementation missteps, a large number of potential enrollees and providers opted out of participation. Although New York and CMS addressed many of the issues, FIDA was plagued by its early negative reputation and declining enrollment throughout the life of the demonstration. Out of over 100,000 eligible beneficiaries, enrollment peaked in October 2015 at 8,833 and declined to 2,320 as of December 2019. In this evaluation report for the New York FIDA demonstration, we describe demonstration implementation activity from 2017 through 2019, and the considerable planning activity during the final demonstration years to create an option to seamlessly transition FIDA enrollees into existing MAP plans aligned with Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) under the same MMP parent organization.3 We include findings from qualitative data for 2017–2019. Using qualitative data gathered throughout the demonstration (2015–2019), we also present overall demonstration successes, challenges, and lessons learned at the end of the report

Financial Alignment Initiative New York Fully Integrated Duals Advantage (FIDA) Program First Evaluation Report

The Medicare-Medicaid Coordination Office and the Innovation Center at the Centers for Medicare & Medicaid Services (CMS) have created the Medicare-Medicaid Financial Alignment Initiative to test, in partnerships with States, integrated care models for Medicare-Medicaid enrollees. CMS contracted with RTI International to monitor the implementation of the demonstrations and to evaluate beneficiary experience, quality, utilization, and cost. This is the first evaluation report for the Fully Integrated Duals Advantage (FIDA) demonstration launched by New York and CMS on January 1, 2015. It describes implementation of the New York FIDA demonstration and early analysis of the services used by New York demonstration eligible beneficiaries. The report includes findings from qualitative data for the demonstration from its initiation on January 1, 2015, through December 31, 2016, and quantitative results for January 1, 2015 through December 31, 2015. To capture relevant information generated at the conclusion of the demonstration period or immediately afterward, this report also includes updated qualitative information through March 2017. Data sources include key informant interviews, beneficiary focus groups, the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results, Medicare claims data, the MMP encounter data, and other demonstration data