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AHCCCS is working to increase alignment and improve service delivery for people covered by both Medicare and Medicaid.
These individuals, commonly referred to as “duals,” are currently navigating multiple systems to receive care. This
fragmentation often results in poor communication, uncoordinated health care decisions and a lack of a patient-centered
perspective. The AHCCCS program has moved toward increasing the connection between these two programs within the Medicare
Dual Special Needs Plans (D-SNP) model by contractually requiring its health plans to serve as D-SNPs and promoting
enrollment or alignment of dual eligible members into the same health plan for both Medicaid and Medicare to the
greatest extent. Enrolling in specialized duals-only Medicare plans allow individuals to receive all of their health
care, including the payment for prescriptions and benefits, from a single, integrated source.
AHCCCS has shown that achieving alignment between two distinct and separate programs – Medicaid and Medicare –
improves the quality and lowers the cost of care provided to dual eligible members. Many members with full
Medicare-Medicaid eligibility have complex health needs and may be better served by a plan that can offer more
benefits and support (a D-SNP), instead of a Medicare Advantage plan or traditional Medicare. To find out more,
or to enroll, current dual AHCCCS members should contact their health plan.
Based on positive outcomes related to greater alignment, AHCCCS has taken measures to increase alignment wherever
possible. For instance, as part of changes related to the October 2013 acute care procurement, the AHCCCS administration
aligned approximately 8,000 dual eligible members by moving them into their Medicare D-SNP’s companion Medicaid plan.
Additional alignment efforts are planned for upcoming years.
For additional information regarding dual alignment please access the following document:
The mission and guiding principles of AHCCCS include a focus on care coordination as a vehicle for appropriate care and
containing costs. Ensuring that members get the health care they need, the growth of the dually eligible population
(those who receive Medicare AND Medicaid benefits) and related ongoing integration efforts have been key factors
in the decision to make changes for dually eligible (also known as ‘duals’) members. Of the 1.6 million AHCCCS
members, over 141,000 are classified as duals (as of mid-2015).
Beginning October 1, 2015, this change requires contracted acute health plans to provide general mental health
and substance abuse (GMH/SA) services to adult dual members. This is a change to the existing delivery method
where the Tribal and Regional Behavioral Health Authority (T/RBHA) contractors serve dual members’ for their
general mental health and substance abuse needs. By taking a proactive approach, AHCCCS will be well-positioned
to effectively navigate possible changes to CMS’ Medicare Advantage program should the definition and scope of a
Dual Eligible Special Needs Plan (a specialized Medicare plan for duals) change in the future. Non-dual acute
members will still use the T/RBHA system for their behavioral health needs just as they do today.
In total, over 80,000 members will be affected by this shift in October 2015. This population includes dual
members enrolled in an AHCCCS acute health plan who also are enrolled in any Medicare Part A and/or B arrangement.
Children, as well as members with Serious Mental Illness (SMI); or those enrolled in ALTCS plans, are excluded
from this effort. Individuals with SMI will not be served in this manner—they will receive care in the integrated
RBHAs in Maricopa County and in Greater Arizona (Mercy Maricopa Integrated Care, Health Choice Integrated Care,
and Cenpatico Integrated Care).
Enrolled American Indians will continue to have the current array of choices offered to them in addition to
the new fully integrated acute plan; therefore some American Indians will be served by acute plans for acute
and behavioral health services and some only for acute services. We anticipate that as dual members, Medicare will
often continue to be the primary payers of behavioral health services.
For additional information regarding the general mental health and substance abuse integration for dual members please access the following documents:
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