Medicare-Medicaid Coordination

By: Taylor

There are many agencies dedicated to the cause of Medicare-Medicaid co-ordination. Medicare-Medicaid Coordination Office is the primary coordinating agencies ensuring coordinated and smooth operation of both the programs in states. There are other agencies such as The Integrated Care Resource Center, which is a technical resource center to help states in better co-ordination and seamless operation of both Medicaid and Medicare.

Medicare-Medicaid Coordination Office

The Federal Coordinated Health Care Office or Medicare-Medicaid Coordination Office is designed to provide services to people enrolled in both Medicare and Medicaid or dual eligible people. It offers all Medicare-Medicaid enrollees full access to flawless, high quality health care. It also tries to make the system cost-effective. It works with the Medicaid and Medicare programs. It aligns with Federal agencies, States and stakeholders to coordinate benefits between the two programs effectively and efficiently. It aims at providing dual eligible individuals full access to the benefits to which they are entitled and simplifying the processes for dual eligible individuals.

Other aims of Medicare-Medicaid Coordination Office to improve the quality of health care and long-term services for dual eligible individuals and increase their understanding and satisfaction with coverage they get. It also eliminates regulatory conflicts between two programs and cost-shifting between two programs. Improving care continuity and ensuring safe and effective care for dual eligible individuals and improving the quality of services by providers and suppliers under the Medicare and Medicaid programs are its other aims.

Qualified Medical Beneficiary

Any beneficiary having both Medicare and Medicaid and availing services covered under Medicare cannot be billed by doctor’s office for any Medicare co-pay costs. Anyone having Medicare Parts A and B or Medicare Part C known as Medicare health plan and getting help from Medicaid to pay for Medicare premium deductibles, and coinsurance is a Qualified Medicare Beneficiary or QMB. But doctors may ask for a Medicaid co-pays. For this the beneficiary should check benefits he is getting through Medicaid. Doctors cannot bill a Qualified Medicare Beneficiary or QMB, even if they do not accept Medicaid. A Qualified Medical Beneficiary’s income does not exceed 100% of the Federal Poverty Limit and is eligible for Medicaid paying Medicare premiums, deductibles, and coinsurance for both Part A and B. even if a Qualified Medical Beneficiary signs a document accepting liability for any treatment costs he cannot be billed as he cannot waive this right under Medicare. Providers who bill a QMB are subject to sanctions. If a beneficiary is moving from one state to another he should get information about Medicaid in the state he intend to reside as Medicaid programs are different in every state.

Integrated Care Resource Center

The Integrated Care Resource Center is a technical resource center created to assist States in delivering coordinated health care to high-need, high-cost beneficiaries. These resource centers are available in all the states and help them technically on all levels to provide better services to beneficiaries, improve quality and reduce costs. The Integrated Care Resource Center is aimed at helping both the Medicare-Medicaid Coordination Office and the CMS Center for Medicaid and CHIP Services.

Assistance provided by Integrated Care Resource Center

It helps in conducting needs assessment and gap analysis.
It helps in development and implementation of health homes.
It offers best practices across States.
It offers technical assistance in program design, stakeholder engagement, data, and health information technology.
It helps in developing resources to coordinate primary, acute, behavioral health, and long-term supports and services. It aims at providing high quality services for high-need, high-cost individuals, including those who are enrolled in Medicare and Medicaid.
States participating in the demonstration to test financial models to support care coordination for Medicare-Medicaid enrolees can avail specific resources through this center.

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