RI Rolls Out Integrated Care Initiative For Elderly, Disabled

Oct 10, 2013

Rhode Islanders who are covered by both Medicare and Medicaid - the so-called "dual eligibles" - take note: you're being enrolled in a new health plan designed to coordinate your primary care and long term care needs a bit better. It's called the Integrated Care Initiative, it could affect nearly 28,000 Rhode Islanders, and it's not without controversy.

But first, what's it about?

The Integrated Care Initiative is a new attempt to manage the care and costs of so-called "dual eligibles," or people who qualify for both Medicare and Medicaid. These are usually the frail elderly or adults with disabilities, often people with little or no means to afford the kind of long term care they need. They often have multiple, chronic health problems that require a mix of costly health care services. And to complicate matters, they must navigate these two different programs - Medicare and Medicaid - that cover different things and don't always play nicely together. (Medicare is federal health insurance coverage for older people; Medicaid is state-based coverage for the poor. Medicare does not cover nursing home stays, for example.)

So Rhode Island is rolling out this new Integrated Care Initiative. Beneficiaries will be receiving letters about it and will be enrolled automatically, although they can opt out if they choose. What do they get if they stay enrolled? According to documents on the Executive Office of Health and Human Services (EOHHS) web site, they'll get more help coordinating long term care, for now. That means help figuring out whether you need to stay in a nursing home or whether you might be better off at home or in the community but with some additional services and supports - like help making meals, or installing a shower bar.

(Read more about the ICI, including copies of consumer letters, presentations for the public, and more here.)

The ICI is being rolled out in phases, so it's only dealing with Medicaid-covered services now. Phase two should include the Medicare part - which covers primary care and prescription drugs, for example - but that's only if the federal government agrees to the plan.

And that's part of the controversy. No less than three op eds appeared in the Projo over the past several weeks, one decrying the way the program is rolling out and two taking issue with that assessment.

Virginia Burke, who heads the Rhode Island Health Care Association, which advocates for nursing homes, penned the first. She questioned whether it made any sense to roll the program out in phases. She criticized the automatic enrollment. And she called on Governor Chafee to exclude nursing home residents until the program is fully rolled out. Her argument was that the program looks confusing, won't provide much benefit to residents, and won't save the state any money. Read between the lines and you might also conclude that nursing homes aren't entirely satisfied with what they could be reimbursed per patient under this new program.

But the program is rolling out. So now we must monitor whether it does what it intends to do: improves care for this group of patients and manages costs for all involved.

EOHHS chief Steven Costantino and Neighborhood Health Plan of Rhode Island (which won one of the ICI contracts) head Jim Hooley defended the program, saying it would help the elderly and disabled stay longer in their own communities and that nursing homes are, basically, too often the default for this population. They argued that there's no time to waste in rolling out the program and excluding one population would be counter-productive.

Who's right? It may be too soon to tell. But both camps make solid points.

Still, the program is rolling out. So now we must monitor whether it does what it intends to do: improves care for this group of patients and manages costs for all involved.

If you or a loved one receives a letter about this new program and you'd like to share your experience with it, I'd be delighted to hear about it.

One more note: The Affordable Care Act (Obamacare) has not only brought about the online health exchanges and the mandate to carry health insurance you've been hearing about. This massive stack of legislation has also made money available to states to try out experiments like this Integrated Care Initiative. Something to keep in mind as politicians talk back and forth about "defunding" Obamacare: it  wouldn't just mean shuttering the online health exchanges. It could have a cascading effect on all of the other Obamacare-associated programs.