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December 11, 2016

Upcoming Changes to the Medicare-Medicaid Coordinated Plan (MMCP)

The Medicare Medicaid Coordinated Plan (MMCP) continues to thrive.  

As of September 1, 2016 the enrollment has increased to 2,493 members.  The MMCP is an integrated healthcare plan exclusively for Idaho Dual Eligibles which includes most Medicaid benefits along with Medicare benefits and an important Care Management component.  A Dual is someone that is on Enhanced Medicaid and Medicare, over the age of 21 and lives in an
eligible county.  The plan is administered by Blue Cross of Idaho.

Currently 42 counties are eligible for the MMCP; however Blue Cross of Idaho has made a business decision not to offer any Medicare plans in the affected counties including the MMCP beginning January 1, 2017.  Currently approximately 200 MMCP members will be affected in the Service Area Reduction.  Blue Cross has sent letters to the members and providers to notify them and has included Frequently Asked Questions. Additionally the BCI Customer Service department has been very helpful in answering questions about the Service Area Reduction and is making every effort to ensure that affected members have a smooth transition back to traditional Medicaid for the affected members.

The affected counties are the following:

Adams, Bear Lake, Benewah, Blaine, Butte, Camas, Caribou, Clearwater, Custer, Franklin, Gooding, Idaho, Jerome, Latah, Lemhi, Lewis, Lincoln,  Oneida, Shoshone, Teton, Valley and Washington.

The Medicare Medicaid Coordinated Plan will continue to be offered in all other counties including: 

Ada, Bannock, Bingham, Boise, Bonner, Bonneville, Boundary, Canyon, Cassia, Clark, Elmore, Fremont, Gem, Jefferson, Kootenai, Madison, Minidoka, Nez Perce, Owyhee, Payette, Power, Twin Falls 

For more information about the Service Area Reduction members and providers can call Blue Cross Customer Service @ 888-495-2583.

'Sky is the Limit' on Membership

The Medicare Medicaid Coordinated Plan (MMCP) is a type of Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP) that enrolls individuals over the age of 21 that are eligible for both Medicare and Medicaid. The MMCP was created as a route to better integration between Medicare and Medicaid, in turn leading to better quality, higher value healthcare for enrollees.

The Idaho Department of Health & Welfare (IDHW) has contracted with Blue Cross of Idaho to administer most of the state’s Medicaid benefits, including long-term care, home and community based services, and the coordination of the delivery of Medicare and Medicaid services. The MMCP is also required to integrate Medicare and Medicaid processes for enrollment, member materials, communications, grievance and appeals, and quality improvement.

In July 2014, the MMCP was enhanced to include Long Term Services and Supports. At the time of implementation the enrollment was under 700 members. As of November 1, 2015 enrollment is over 1,800 members, an increase of 163% in 15 months. So what is the secret to the success of the MMCP? In addition to Care Coordination, the State’s program offers several benefits that may account for part of its popularity. These include an annual eye exam and $100.00 toward eyewear, one Blue Cross of Idaho Identification card for all medical and pharmaceutical services, access to the Blue Cross of Idaho provider network, and the star of the benefits – Care Coordination.

As evidence of the commitment to improving the quality of healthcare to Idaho Duals, Blue Cross has announced a pilot program exclusively for MMCP participants called Home Stay. The pilot program is designed to allow participants with chronic conditions to live in their own residence for as long as possible by:

1.  Detecting early changes in functional status that can lead to medical decompensation, emergency room visits, or inpatient hospital stays,

2.  Serving as an additional level of virtual HIPAA-compliant monitoring that can provide useful information to the enrollee and their care giver team, and

3.  Avoiding or delaying the need to move to a long-term care facility by providing the participant a higher level of support.

Home Stay uses remote monitoring to establish a baseline, then detects variations in the participant’s daily routine. Changes in activity are examined, then determined if the change is an early indicator of deterioration in function, or linked to an acute health issue. If the change is ruled a potential health risk, notification is sent to a clinical team for review and contact to the participant to determine if help is needed. Home Stay is a time limited program scheduled to begin in January 2016. The service is free of charge, voluntary, and enrollees can discontinue at any time.

In a recent statewide outreach, IDHW and Blue Cross held meetings at all major cities across Idaho to inform eligible Duals about the MMCP. Enrollment skyrocketed with members, providers, and advocates offering unsolicited praises of the program. Linda of Pocatello states:

I like Blue Cross and the Special Needs Plan because they work with me. They go above my expectations to help me understand my benefits and get the help I really need, and to get the services and the hours I need. I get my Medicare and Medicaid paid for, and I also have vision and dental benefits. Blue Cross really cares what happens to me.

Currently the MMCP is available in 33 of the 44 Idaho counties; however, in 2016 it will be available in ALL counties with the exception of Lemhi and Franklin. Enrollment is voluntary and applications can be taken over the phone by simply calling Blue Cross of Idaho at 1 (888) 495-2583.

Medicare-Medicaid Coordinated Plan (MMCP)

The Medicare-Medicaid Coordinated Plan (MMCP) is for participants who are eligible and enrolled for both Medicare and Medicaid.

Since 2006, the Division of Medicaid has offered the MMCP to provide a coordinated health coverage plan that has the following features:

    • It allows you to receive your Medicare benefits from a private plan rather than from the traditional fee-for-service (FFS) program.
    • It allows Medicaid to pay your Medicare premium for you.
    • It may give you better access to providers.
    • It may cover more of the medical services you need.
    • It’s easy to use. Just show your Medicare Advantage Plan identification card for services.

Signing up for a Medicare Advantage Plan is voluntary.  Medicaid will continue to pay for services such as long-term care, personal care, and developmental disability services.

The MMCP covers all medically-necessary and preventive services covered under Medicare Part A, Part B and prescription drug coverage under Part D as well as additional services covered by Medicaid. The MMCP also covers additional services over and above original Medicare/Medicaid, such as:

    • Care Coordination
    • Dental
    • Vision
    • Call-in 24 Hour Nurseline
    • Fitness Benefit

The MMCP is available in the following counties:

Ada, Adams, Bannock, Benewah, Bingham, Blaine, Boise, Bonner, Bonneville, Boundary, Canyon, Caribou, Cassia, Clark, Elmore, Fremont, Gem, Gooding, Jefferson, Jerome, Kootenai, Latah, Madison, Minidoka, Nez Perce, Oneida, Owyhee, Payette, Power, Shoshone, Twin Falls, Valley, and Washington counties.

If you have questions or would like more information, please call Division of Medicaid, Bureau of Long Term Care at (208) 287-1156 or Blue Cross at (888) 495-2583. 

Performance Dashboard

The Idaho Department of Health & Welfare (IDHW) in partnership with Blue Cross of Idaho has developed a performance dashboard for the Medicaid Medicare Coordinated Plan (MMCP).  Key indicators were selected to assess the overall performance of the program, identify areas of strength and guide priorities for improvement

The MMCP Dashboard is a monitoring tool updated quarterly by IDHW. The Dashboard contains comprehensive data on a variety of measures including Enrollment, Care Coordination, Providers, and Claims.

Performance monitoring allows IDHW to create appropriate policies for improving the health outcomes of Idaho’s Duals enrolled in the MMCP and to ensure access to high quality health care. 

Click on the icon below to access the dashboard.

Medicare-Medicaid Coordinate Plan Dashboard

Participating Health Plans