Texas Dual Eligible Integrated Care Project
In July 2011, the federal Center for Medicare and Medicaid Innovation within the Centers for Medicare and Medicaid Services (CMS), presented states with an opportunity to develop demonstration projects to integrate care for fully dual eligible individuals. Full dual eligibles are individuals who are eligible for Medicare and full Medicaid benefits.
The goal of this demonstration project is to achieve savings and reduce costs through integrated and improved care management for Medicaid and Medicare services for these individuals. Participating states will negotiate with CMS to retain a portion of the savings achieved through implementation of this initiative.
In response to this demonstration project opportunity, the Texas Health and Human Services Commission (HHSC) is proposing a fully integrated, capitated approach that involves a three-party agreement between a managed care organization (MCO) that has both an existing STAR+PLUS contract and a Medicare Advantage Special Needs Plan contract with the federal government. The three-party agreement will be between that MCO, the state and CMS for the provision of full array of Medicaid and Medicare services.
HHSC posted a draft application on April 11, 2012, and accepted comments on it for a month. HHSC also conducted public meetings on April 19 and May 2 to get input on the application.
On May 31, 2012, HHSC submitted the final application (PDF) to CMS.