Proposal For Dual Eligibles Now Out For Public Comment


Late today, the HCA and DSHS, working in coordination, released a proposal to “improve the care experience” of “individuals who receive services from both Medicare and Medicaid,” otherwise known colloquially as the “dual eligible” population.

The 75-page proposal is the product of a 18 month planning grant from CMS “to develop a multi-phased design and implementation plan” to coordinate and pay for care for this population.

The proposal, which targets the 115,000 Washington dual eligible citizens, relies on three payment strategies to drive delivery reform, all of which are hybrid capitation models.

Strategy 1:  Health Homes – Managed fee for service financial model

Strategy 2:  Full Integration Capitation – Three-way capitation financial model

Strategy 3:  Modernized and consolidated service delivery with shared outcomes and aligned financial incentives – Design Plan Model with capitation and fee for service

The state is taking public comment for 30 days on the proposal and can be emailed at  Alternatively, respondents can complete this survey on the proposal to provide feedback.  The full project website can be found here.