Author: United States Government Accountability Office

Publisher: Createspace Independent Publishing Platform

Published: 2017-09-23

Total Pages: 48

ISBN-13: 9781977545091

The Medicare and Medicaid programs spent an estimated $300 billion on dual-eligible beneficiaries-those individuals who qualify for both programs-in 2010. These beneficiaries often have complex health needs, increasing the need for care coordination across the two programs. In 2013, CMS began the Financial Alignment Demonstration, with the goal of integrating Medicare and Medicaid services and financing and improving care coordination. Thirteen states are participating. GAO was asked to examine care coordination under the demonstration. GAO examined (1) how integrated care organizations-which are health plans or other entities-are implementing care coordination and (2) what, if any, challenges organizations have encountered in implementing care coordination and the extent to which CMS oversees these care coordination activities. GAO interviewed officials from CMS and, during site visits to a nongeneralizable sample of the first five states to implement the demonstration, interviewed state officials, organizations, advocacy groups, and providers. GAO also reviewed CMS guidance outlining CMS's oversight role and the measures it uses to monitor the demonstration.