Health care initiative launched to improve care for elders, adults with disabilities

THE STATE Executive Office of Health and Human Services, the federal Centers for Medicare & Medicaid Services and Neighborhood Health Plan of Rhode Island announced a three-way contract that paves the path for an innovative health care initiative for some of Rhode Island’s most vulnerable residents.
THE STATE Executive Office of Health and Human Services, the federal Centers for Medicare & Medicaid Services and Neighborhood Health Plan of Rhode Island announced a three-way contract that paves the path for an innovative health care initiative for some of Rhode Island’s most vulnerable residents.

PROVIDENCE – The state Executive Office of Health and Human Services, the federal Centers for Medicare & Medicaid Services and Neighborhood Health Plan of Rhode Island announced April 28 a three-way contract that paves the path for an innovative health care initiative for some of Rhode Island’s most vulnerable residents.

This new program – the EOHHS Integrated Care Initiative’s second phase – should improve services and help control costs for the 10,000 to 14,000 individuals expected to enroll.

In the Integrated Care Initiative’s first phase, EOHHS established a new Medicaid-managed care program called Rhody Health Options, which allows beneficiaries with both Medicare and Medicaid, as well as Medicaid beneficiaries receiving long-term care services, to enroll in Neighborhood to coordinate their Medicaid services. The Integrated Care Initiative’s second phase creates a new Neighborhood Medicare-Medicaid plan to provide an integrated set of benefits for enrollees, with a goal of person-centered care.

According to EOHHS, some 30,000 Rhode Islanders – generally older individuals or adults with disabilities with multiple health care needs and insufficient economic resources – are eligible for both Medicaid and Medicare. Because the two systems operate separately, offer different benefits and adopt different rules, dual-eligible enrollees often receive fragmented and expensive care. The Ocean State’s Integrated Care Initiative is designed to address this problem.

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By integrating Medicare and Medicaid benefits, the new plan will simplify access to improved health care, at a reduced cost. Care coordinators will help these individuals manage primary and hospital care, behavioral health, social services and long-term services and supports. Rhode Island will receive approximately $300,000 in federal funds each year for ombudsman and enrollment counseling support to beneficiaries, an EOHHS spokesperson told Providence Business News. Rhode Island is one of only 13 states approved by the CMS to provide these integrated benefits to dual-eligible cohorts.

Dual-eligible individuals will be eligible to join Neighborhood’s new program, called INTEGRITY, beginning this summer.

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