​To read Maryland's State Health System Innovation Plan, click here.

Medicaid and Medicare Dual Eligibles Care Delivery Strategy

Through a Round Two State​ Innovation Model (SIM) grant from the Center for Medicare and Medicaid Innovation (CMMI), Maryland is developing a strategy to integrate care delivery for individuals who are dually-eligible for both the Medicaid and Medicare health care programs (dual eligibles).
In 2012, the Maryland Medicaid program served over 88,000 recipients eligible for full Medicaid and Medicare benefits.  Dual eligibles often have complex health conditions, with 43 percent of full-benefit dual eligibles having six or more chronic conditions, such as high blood pressure, high cholesterol, anemia, diabetes and Alzheimer’s disease.  Although these individuals make up just 12 percent of the Medicaid population statewide, they account for a disproportionate share of Medicaid expenditures.  In 2012, the expenditures for dual eligible beneficiaries totaled $2.9 billion, of which approximately half were Medicaid expenditures.  While dual eligibles have access to comprehensive benefit packages from both Medicaid and Medicare to ensure they can access the care they need, the care received is often fragmented.   
The Department established a Workgroup to discuss these topics and to develop a model of care for the dually eligible population.  The SIM funding ends December 2016 for this stakeholder work, but the Department will contiune planning the detailed design work into 2017. 
At the conclusion of the Duals Care Delivery Workgroup meeting on November 15th, the Department announced that it would disseminate a Concept Paper as a summation of the work discussed by the Duals Care Delivery Workgroup over the last year on an Accountable Care Organization for Dual Eligibles (D-ACO). The Concept Paper can be found here.

The Concept Paper is intended to be a point of reference for the State's future discussions with stakeholders in 2017. There is more design work to be done on further developing the D-ACO Model and aligning it with the State's All-Payer Model progression and the Maryland Comprehensive Primary Care Model.

Accordingly, the Concept Paper is not a formal proposal to CMS, but rather a discussion draft that will enable the Department to receive stakeholder comments and feedback on a D-ACO model that will best work for Maryland as we continue design work in 2017. DHMH will be accepting comments from all interested parties from now through December 30th, 2016. Please send your comments and questions to: dhmh.sim@maryland.gov.

Please note that the Department will also be posting the final SIM report - which describes all of our SIM efforts - next week for public comment.