Summary Data for Texas Compiled by Special Needs Consulting Services SNCS Key Information Texas Texas has roughly 350000 full duals 67 of these persons are age 65 The full duals annual costs across Medicaid and Medicare now total approximately 300 billion roughly 500 ID: 644497
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ACAP Dual Eligibles Toolkit:Summary Data for Texas
Compiled by: Special Needs Consulting Services (SNCS)Slide2
Key Information, Texas
Texas has roughly 350,000 “full duals”67% of these persons are age 65+The full duals’ annual costs (across Medicaid and Medicare) now total approximately $300 billion – roughly $50,000 per person per year
53% of these expenditures are paid for by Medicaid
SNCS estimates that 13.1% of Texas’ duals’ costs are currently paid via capitation; 86.9% via FFS
Texas plans to participate in CMS Capitation Alignment Demonstration, with initial enrollment effective January 2013
MCOs
interested in serving duals under this demonstration need to engage in significant preparations during CY2012 (and CY2013)
Average lifetime revenue for
each
dual eligible enrolled is likely
to approach or
exceed $500,000, since most duals will remain eligible and enrolled for remainder of their lives (which should average > 10 years)
The high needs and high costs, coupled with the “rest of life” enrollment dynamic, creates profound and exciting care coordination opportunities
Moving Texas’ duals into coordinated care also makes market positioning critically
important
for
MCOs interested in serving this subgroupSlide3
Estimated PMPM Cost, Texas Full Duals, 2008
Texas
Age <65
Age 65+
All Full Duals
Average Eligibles
109,692
228,598
338,290
Total Medicaid Cost
$1,034
$924
$960
Nursing Home
$125
$472
$360
Capitated Care
$100
$88
$92
HCBS Waiver & Prosthetics
$329
$238
$267
Personal Support
$28
$53
$45
ICF/MR
$361
$25
$134
All Other Medicaid
$91
$49
$62
Estimated Medicare Costs
$1,119
$1,345
$1,272
Part A
$371
$496
$455
Part B
$465
$564
$532
Part D
$283
$286
$285
Total Costs, Medicaid & Medicare
$2,153
$2,269
$2,232 Slide4
Estimated Total Dollar Cost, Texas Full Duals, 2008
Texas
Age <65
Age 65+
All Full Duals
Average Eligibles
109,692
228,598
338,290
Total Medicaid Cost
$1,361,020,316
$2,534,736,534
$3,895,756,850
Nursing Home
$164,423,742
$1,295,886,434
$1,460,310,176
Capitated Care
$131,346,783
$242,072,567
$373,419,350
HCBS Waiver & Prosthetics
$433,659,834
$651,608,427
$1,085,268,261
Personal Support
$36,763,523
$144,193,264
$180,956,787
ICF/MR
$474,959,904
$67,693,472
$542,653,376
All Other Medicaid
$119,866,530
$133,282,370
$253,148,900
Estimated Medicare Costs
$1,472,699,004
$3,690,342,791
$5,163,041,795
Part A
$488,955,947
$1,359,388,792
$1,848,344,739
Part B
$611,826,693
$1,546,614,589
$2,158,441,282
Part D
$371,916,365
$784,339,409
$1,156,255,774
Total Costs, Medicaid & Medicare
$2,833,719,320
$6,225,079,325
$9,058,798,645 Slide5
Publicly Available Resources Containing Data and/or Other Information About Texas' Dual Eligibles
Medicare-Medicaid Enrollee State Profile, Texas, Centers for Medicare & Medicaid Services
http
://www.integratedcareresourcecenter.com/PDFs/
StateProfileTX.pdf
Texas Dual
Eligibles
Integrated Care
Demonstration Project
http://www.hhsc.state.tx.us/medicaid/dep/docs/tx-icm-dual-eligibles.pdf
Achieving
Optimal Care Coordination for Medicaid/Medicare Dual
Eligibles
, August 2011, Special
Needs Consulting
Services (Joel Menges, Jeremy Batt, Kaleigh Beronja, Jessica Wiecezak)
http://www.sncservices.com/Achieving%20Optimal%20Care%20Coordination%20for%20Dual%20Eligibles-%20FINAL.pdf