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Dual-Eligible Initiative

Coordinating care for individuals covered by both Medicare and Medicaid

Dual Eligible Planning Grant Opportunity

North Carolina has a unique opportunity to improve how health and support services are provided to North Carolinians enrolled in both Medicare and Medicaid (Dual Eligibles). The state was awarded a planning grant to support the development of a strategic framework and implementation plan for a statewide demonstration model of care to improve the quality and costs of care for dual eligibles. This work has begun under the guidance of the NC Division of Medical Assistance (DMA) and Community Care of North Carolina (CCNC) and other Department of Health and Human Services (DHHS) Divisions serving dually eligible beneficiaries. This work is made possible by a planning grant (State Demonstration to Integrate Care for Dual Eligibles) awarded by the federal Centers for Medicare & Medicaid Innovation (CMMI), in partnership with the Federal Coordinated Health Care Office (FCHCO). North Carolina is one of 15 states afforded this opportunity and has one year in which to plan and develop a draft implementation plan.

Final proposal 

 North Carolina's proposal to CMS on the 'State Demonstration to Integrate Care for Dual Eligible Individuals' was submitted on May 1, 2012. The link below will provide the condensed version of the document as well as the letters of support received for the proposal from our partners.    

You can continue to use the email address: dualfuture@n3cn.org  to share your thoughts, concerns and suggestions with us on issues that impact the dual eligible beneficiaries as well as on the documents posted on this website.

 North Carolina State Demonstration to Integrate Care for Dual Eligible Individuals: Dual Eligible Beneficiary- Integrated Delivery Model Strategic Framework (.Pdf)

North Carolina State Demonstration to Integrate Care for Dual Eligible Individuals (.Pdf) (MS Word)

Letters Received in Support of the Proposal (.Pdf) (MS Word)

North Carolina's Responses to CMS Questions on the State FFS Dual Demonstration Proposal (.pdf)

North Carolina's Responses to CMS Questions on the State FFS Dual Demonstration (Part 2) (.pdf)

North Carolina's Responses to CMS Questions on the State FFS Dual Demonstration (Part 3) (.pdf)

The US Department of Health and Human Services announced that Massachusetts will become the first State to partner with the Centers for Medicare & Medicaid Services to test a new model for providing more person-centered, coordinated care to Medicare-Medicaid enrollees. Under a capitated financial alignment model, Massachusetts and CMS will contract with Integrated Care Organizations (ICOs) that will oversee and be accountable for the delivery of Medicare, Medicaid and expanded services for Medicare-Medicaid enrollees in Massachusetts ages 21-64.  The program is expected to launch on April 1, 2013.  The press release can be accessed here. More information is available at http://www.cms.gov/apps/media/fact_sheets.asp. The Massachusetts MOU is also posted online at http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialModelstoSupportStatesEffortsinCareCoordination.html.

On November 5th, the Department of Health and Human Services announced that the State of Washington with partner with CMS tp test a new model for providing more person-centered, coordinated care to medicare-medicaid enrollees. Washington is the first state with approval for a managed fee for service (MFFS) Demonstration to better integrate and coordinate care delivery for  dual beneficiaries. The foundation of the Demonstration will be Washington’s planned Medicaid Health Homes. As part of the Demonstration, beneficiaries and their families will have access to enhanced support to improve coordination of care and the beneficiary experience.  The new program is expected to launch  April 2013 and over 20,000 beneficiaries will be eligible.The Washington MFFS Memorandum of Understanding is available at: https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/WAMFFSMOU.pdf

Questions?  Concerns?  Contact the Dual-Eligible Staff. 

• Beacon Community
• Care Coordination for Children (CC4C)
• CCNC Adult Care Home Workgroup
• Child Health Accountable Care Collaborative
  • CHACC Clinical Guidelines CHACC GI Guidelines
• Clinical Integrity
• Dual-Eligible Initiative
  • Duals Project Timeline Long-Term Services and Supports Work Group Medical/Health Homes & Population Management Work Group Transitions Across Settings & Providers Work Group Behavioral Health Integration Work Group Payment and Delivery System Integration Work Group Beneficiaries and Community Stakeholders Workgroup CCNC Dual-Eligibles Team Duals Video Partners in the Dual-Eligible Grant
• Medicare Quality Demonstration (646 Waiver)
• Multi-Payer Demonstration
  • PCMH Central Redirect MAPCP FAQ
• Palliative Care Initiative
• CCNC PCMH Resource Center
  • PCMH team 2008 PCMH Resources 2011 PCMH Resources Comprehensive PCMH Document Library 2011
• Pregnancy Medical Home
  • PMH Pathways