ACAP Dual Eligibles Toolkit Summary Data for Virginia
This toolkit provides key information on Virginia's full duals, their annual costs, estimated PMPM cost, and total dollar cost. It highlights the significant opportunities and challenges in providing coordinated care for this subgroup of individuals.
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ACAP Dual Eligibles Toolkit: Summary Data for Virginia Compiled by: Special Needs Consulting Services (SNCS)
Key Information, Virginia Virginia has roughly 110,000 full duals 59% 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 3.5% of Virginia s duals costs are currently paid via capitation; 96.5% via FFS Virginia 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 Virginia s duals into coordinated care also makes market positioning critically important for MCOs interested in serving this subgroup
Estimated PMPM Cost, Virginia Full Duals, 2008 Virginia Age <65 Age 65+ All Full Duals Average Eligibles 44,073 63,408 107,481 Total Medicaid Cost $1,262 $1,175 $1,211 Nursing Home $164 $742 $505 Capitated Care $20 $7 $12 HCBS Waiver & Prosthetics $571 $80 $281 Personal Support $67 $156 $120 ICF/MR $270 $50 $140 All Other Medicaid $172 $140 $153 Estimated Medicare Costs $1,008 $1,178 $1,108 Part A $282 $404 $354 Part B $299 $406 $362 Part D $428 $368 $392 Total Costs, Medicaid & Medicare $2,271 $2,353 $2,319
Estimated Total Dollar Cost, Virginia Full Duals, 2008 Virginia Age <65 Age 65+ All Full Duals Average Eligibles 44,073 63,408 107,481 Total Medicaid Cost $667,709,038 $893,799,752 $1,561,508,790 Nursing Home $86,934,438 $564,730,439 $651,664,877 Capitated Care $10,350,446 $4,959,082 $15,309,528 HCBS Waiver & Prosthetics $301,751,480 $61,065,479 $362,816,959 Personal Support $35,270,637 $119,017,353 $154,287,990 ICF/MR $142,557,749 $37,830,886 $180,388,635 All Other Medicaid $90,844,288 $106,196,513 $197,040,801 Estimated Medicare Costs $533,163,998 $896,388,574 $1,429,552,573 Part A $148,979,338 $307,557,928 $456,537,266 Part B $157,909,441 $309,051,563 $466,961,004 Part D $226,275,219 $279,779,083 $506,054,302 Total Costs, Medicaid & Medicare $1,200,873,036 $1,790,188,326 $2,991,061,363
Publicly Available Resources Containing Data and/or Other Information About Virginia s Dual Eligibles Medicare-Medicaid Enrollee State Profile, Virginia, Centers for Medicare & Medicaid Services http://www.integratedcareresourcecenter.com/PDFs/StateProfileVA.pdf State Demonstration to Integrate Care for Dual Eligible Individuals, Commonwealth of Virginia s Proposal http://www.dmas.virginia.gov/Content_atchs/altc/altc-icp1.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%20Coordinati on%20for%20Dual%20Eligibles-%20FINAL.pdf
