Health Care Law Blog

Michigan's Integrated Care Proposal for Individuals Eligible for both Medicare and Medicaid

On April 26, 2012, the State of Michigan submitted its Integrated Care Proposal (Pilot Program) to the Centers for Medicare and Medicaid Services (CMS), for review and approval.  The Pilot Program is Michigan’s plan to jointly manage the care of approximately 200,000 residents who are eligible for both Medicare and Medicaid.  The Pilot Program submitted to CMS is not yet available on the Internet for public review.  However, the Department of Community Health has prepared a list of FAQs about the Program on its website.

Michigan is one of only 15 states that have submitted a proposal to CMS to integrate the delivery system for dual coverage.  This is surprising given the goal is to avoid duplication and reduce costs by integrating the health care delivery system for those covered by both Medicare and Medicaid.

CMS will conduct its own 30-day public review of the Pilot Program.  If the State's Pilot Program meets CMS approval, the State will negotiate a memorandum of understanding (an "MOU") with CMS.  Following an approval of the MOU, Michigan will undergo a procurement process with CMS to select qualified health plans to provide integrated care during the Pilot Program that would last three years.

The Department hopes to send out requests for proposal in the early fall 2012 to those entities interested in participating in the Pilot Program.  Those who are chosen will enter into a three-party contract among CMS, the State, and the health plan that is chosen.

Categories: Insurance, Medicare/Medicaid

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