Overview of Minnesota’s Dual-Eligible Programs

Reston, Virginia—For 15 years, Minnesota has implemented programs to care for dual eligibles, people who are eligible for both Medicare and Medicaid. The state has focused on treating the group through managed care and integrated care philosophies to keep costs down and improve the health of patients who typically utilize a disproportionate share of healthcare resources.

Sue R. Kvendru, coordinator for seniors managed care programs and special needs purchasing in Minnesota’s Department of Human Services, discussed the state’s initiatives at the Leadership Summit on Medicaid Managed Care during a session titled Case Study of the Minnesota Dual Eligible’s Program and Management. Ms. Kvendru explained that because Medicare and Medicaid have different financing and benefit structures, it is difficult to manage the approximately 10 million dual eligibles in the United States.

They are also much more costly to treat than someone in the general population. For instance, Ms. Kvendru cited a January 2011 study from the Kaiser Family Foundation that found that dual eligibles accounted for 21% of the 43 million people in Medicare in 2006 but 36% of the $299 billion in Medicare spending. In addition, 15% of the 58 million people in Medicaid in 2007 accounted for 39% of the $311 billion in Medicaid spending. When Minnesota enrolled its first dual-eligible person on March 1, 1997, the state did not only emphasize saving money but also “doing the right thing,” according to Ms. Kvendru.

Some characteristics of the integrated care program include the same enrollment requirements for Medicare and Medicaid, the same member materials, the same provider billings, and the same provider networks. Minnesota has 2 integrated programs for people who are ≥65 years of age and eligible for Medicaid. There are 11,500 people enrolled in Minnesota SeniorCare Plus (MSC+), a mandatory managed long-term care program. There are also 37,000 people enrolled in Minnesota Senior Health Options (MSHO), which was the first Centers for Medicare & Medicaid Services dual-eligible demonstration project in 1995.

The program is now an alternative to MSC+ and serves 70% of Medicaid seniors. It integrates primary, acute, and long-term care and contracts with 8 dual-eligible special needs plans. The state also has a Special Needs BasicCare program for people with disabilities who are <65 years of age. Ms. Kvendru said of the 12,000 people enrolled in the program, >60% have mental health diagnoses. An important part of the integrated Medicare and Medicaid program, according to Ms. Kvendru, is that each person is assigned a care coordinator who assists with coordinating primary, acute, and long-term care services.

Care coordinators are typically registered nurses, nurse practitioners, or social workers whose duties include conducting health risk assessments, monitoring chronic conditions, facilitating primary care visits, and communicating with physicians. “Care coordination is key,” Ms. Kvendru said. The programs have been successful. Between 2006 and 2009, Minnesota increased access to home and community services by 48% while reducing long-term nursing home use by 22%, according to Ms. Kvendru. She added that per person costs were less than or equal to projections, and 98% of people enrolled in the MSHO program have annual primary care visits.