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Advisory group warns data limits complicate including Medicare‑Medicaid duals in Medicaid reform
Summary
Stakeholders advised excluding dually eligible Medicare‑Medicaid members from the initial primary‑care payment redesign because the state lacks comprehensive Medicare data and Medicare is the primary payer for primary‑care services for that population.
Advisory‑group participants spent a sustained portion of the meeting discussing whether and how to include Medicare‑Medicaid duals in any Medicaid primary‑care payment reform.
Presenter (S1) and other participants explained the practical barrier: Medicaid lacks comprehensive access to Medicare claims and encounter data, making it difficult for the state to construct accurate attribution and benchmarking if Medicare is the primary payer. Presenter (S2) said the proposed exclusion recognizes that “Medicaid are not the primary payer for primary care” for dually eligible members, and that integrating Medicare data would require separate technical work and likely a distinct work stream.
Panelists noted that Medicare does track many quality outcomes for duals through MSSP and Medicare Advantage special‑needs plans, but state reporting and operational control are limited without fuller Medicare data access. Several participants suggested pursuing models that align incentives between Medicare and Medicaid over time, but agreed the topic was sufficiently complex to be handled separately from the immediate Medicaid‑only policy design.
Presenters said the technical‑design subcommittee should consider dual integration as a future work stream and explore options for data sharing and coordinated benchmarks as longer‑term possibilities. No formal direction was adopted during the meeting; participants concluded that initial implementation should focus on members for whom Medicaid is the primary payer.
