Summary Data on California Dual Eligibles
ACAP Dual Eligibles Toolkit:
Summary Data for California
Compiled by: Special Needs
Consulting Services (SNCS)
Key Information, California
•
Massachusetts has roughly 1.1 million “full duals”
–
70% of these persons are age 65+
•
The full duals’ annual costs (across Medicaid and Medicare) now total
approximately $300 billion – roughly $50,000 per person per year
–
53% of these expenditures are paid for by Medicaid
–
SNCS estimates that 20.2% of California’s duals’ costs are currently paid via
capitation; 79.8% via FFS
•
California plans to participate in CMS Capitation Alignment
Demonstration, with initial enrollment effective January 2013
•
MCOs interested in serving duals under this demonstration need to
engage in significant preparations during CY2012 (and CY2013)
–
Average lifetime revenue for
each
dual eligible enrolled is likely to approach or
exceed $500,000, since most duals will remain eligible and enrolled for
remainder of their lives (which should average > 10 years)
–
The high needs and high costs, coupled with the “rest of life” enrollment
dynamic, creates profound and exciting care coordination opportunities
–
Moving California’s duals into coordinated care also makes market positioning
critically important for MCOs interested in serving this subgroup
Estimated PMPM Cost,
California Full Duals, 2008
Estimated Total Dollar Cost,
California Full Duals, 2008
Publicly Available Resources Containing Data and/or
Other Information About California’s Dual Eligibles
•
Medicare-Medicaid Enrollee State Profile, California, Centers for
Medicare & Medicaid Services
http://www.integratedcareresourcecenter.com/PDFs/StateProfileCA.pdf
•
Proposed Capitated Financial Alignment Demonstration, California
Coordinated Care Initiative (CCI), Summary
http://viohlandassociates.com/files/documents/Proposed-Capitated-
Financial-Alignment-Demonstration---California.pdf
•
Achieving Optimal Care Coordination for Medicaid/Medicare Dual Eligibles,
August 2011, Special Needs Consulting Services (Joel Menges, Jeremy Batt,
Kaleigh Beronja, Jessica Wiecezak)
http://www.sncservices.com/Achieving%20Optimal%20Care%20Coordinati
on%20for%20Dual%20Eligibles-%20FINAL.pdf
Summary data for California dual eligibles compiled by Special Needs Consulting Services (SNCS) reveals key information about full duals in the state. With approximately 1.1 million full duals, the annual costs total around $300 billion, averaging $50,000 per person per year. A significant portion of these costs are paid for by Medicaid. The report also highlights the distribution of costs between Medicaid and Medicare, estimating the total costs for different categories of services.
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Presentation Transcript
ACAP Dual Eligibles Toolkit: Summary Data for California Compiled by: Special Needs Consulting Services (SNCS)
Key Information, California Massachusetts has roughly 1.1 million full duals 70% of these persons are age 65+ The full duals annual costs (across Medicaid and Medicare) now total approximately $300 billion roughly $50,000 per person per year 53% of these expenditures are paid for by Medicaid SNCS estimates that 20.2% of California s duals costs are currently paid via capitation; 79.8% via FFS California plans to participate in CMS Capitation Alignment Demonstration, with initial enrollment effective January 2013 MCOs interested in serving duals under this demonstration need to engage in significant preparations during CY2012 (and CY2013) Average lifetime revenue for each dual eligible enrolled is likely to approach or exceed $500,000, since most duals will remain eligible and enrolled for remainder of their lives (which should average > 10 years) The high needs and high costs, coupled with the rest of life enrollment dynamic, creates profound and exciting care coordination opportunities Moving California s duals into coordinated care also makes market positioning critically important for MCOs interested in serving this subgroup
Estimated PMPM Cost, California Full Duals, 2008 California Age <65 Age 65+ All Full Duals Average Eligibles 319,495 760,889 1,080,384 Total Medicaid Cost $966 $836 $875 Nursing Home $126 $289 $241 Capitated Care $131 $127 $128 HCBS Waiver & Prosthetics $221 $30 $86 Personal Support $271 $303 $294 ICF/MR $102 $5 $34 All Other Medicaid $115 $82 $92 Estimated Medicare Costs $1,123 $1,280 $1,234 Part A $390 $535 $492 Part B $352 $494 $452 Part D $380 $251 $289 Total Costs, Medicaid & Medicare $2,089 $2,116 $2,108
Estimated Total Dollar Cost, California Full Duals, 2008 California Age <65 Age 65+ All Full Duals Average Eligibles 319,495 760,889 1,080,384 Total Medicaid Cost $3,703,483,213 $7,634,819,100 $11,338,302,313 Nursing Home $482,742,672 $2,639,337,941 $3,122,080,613 Capitated Care $503,319,343 $1,155,125,812 $1,658,445,155 HCBS Waiver & Prosthetics $847,471,984 $273,816,309 $1,121,288,293 Personal Support $1,038,599,481 $2,769,305,668 $3,807,905,149 ICF/MR $392,009,744 $48,545,842 $440,555,586 All Other Medicaid $439,339,989 $748,687,528 $1,188,027,517 Estimated Medicare Costs $4,303,792,211 $11,689,365,474 $15,993,157,685 Part A $1,494,898,746 $4,883,760,353 $6,378,659,098 Part B $1,351,405,604 $4,511,692,286 $5,863,097,890 Part D $1,457,487,861 $2,293,912,836 $3,751,400,697 Total Costs, Medicaid & Medicare $8,007,275,424 $19,324,184,574 $27,331,459,998
Publicly Available Resources Containing Data and/or Other Information About California s Dual Eligibles Medicare-Medicaid Enrollee State Profile, California, Centers for Medicare & Medicaid Services http://www.integratedcareresourcecenter.com/PDFs/StateProfileCA.pdf Proposed Capitated Financial Alignment Demonstration, California Coordinated Care Initiative (CCI), Summary http://viohlandassociates.com/files/documents/Proposed-Capitated- Financial-Alignment-Demonstration---California.pdf Achieving Optimal Care Coordination for Medicaid/Medicare Dual Eligibles, August 2011, Special Needs Consulting Services (Joel Menges, Jeremy Batt, Kaleigh Beronja, Jessica Wiecezak) http://www.sncservices.com/Achieving%20Optimal%20Care%20Coordinati on%20for%20Dual%20Eligibles-%20FINAL.pdf
