Michigan signed an Memorandum of Understanding with CMS on 4/3/2014. The Michigan Department of Community Health (MDCH) developed a demonstration to strengthen services and support for individuals who are dually eligible for Medicare and Medicaid. In the demonstration, services and supports for persons who are dually eligible will be delivered by newly created Integrated Care Organizations (ICOs) and currently existing Prepaid Inpatient Health Plans (PIHPs). ICOs will be responsible for the provision of all physical health, long term care, and pharmacy services, while PIHPs will be expected to cover behavioral health and habilitative services for people with developmental disabilities, mental illness, or substance use issues. The ICOs and PIHPs will be connected through the Care Bridge, a care model that requires the coordination of services and supports between the two entities and involved providers.
Medicare and Medicaid will each contribute to the total capitation payment consistent with baseline spending contributions; Demonstration savings percentages assume that ICOs are responsible for the full range of covered services under the Demonstration; Aggregate savings percentages will be applied equally to the Medicaid and Medicare A/B components; and Both CMS and MDCH will contribute to the methodologies used to develop their respective components of the overall blended rate. More information on the demonstration's payment model can be found in Appendix 6 of the approved contract with CMS.
