Michigan’s Journey to
Integrated Care for
Dual Eligibles
Alison Hirschel
Michigan Poverty Law Program &
Michigan Voices for Better Health
The Basics…Michigan’s
demonstration project
 Implementation in four regions of the
state beginning July 1, 2014
 Will affect 104,000 individuals
 Most dually eligible individuals will be
passively enrolled; all beneficiaries can
opt out or change plans on a monthly
basis.
A unique twist…
 Primary care, acute care, and long term
services and supports will be provided
by managed care organizations (“ICOs”)
 Mental/behavioral health services will be
provided by existing managed mental
health care system. (“PIHPs”)
 Care between the ICOs and the PIHPs
will be coordinated across a “Care
Bridge”
State’s goals for ICDE:
 Improved quality and enrollee
satisfaction
 “Choice and voice” for consumers
 Seamless access to services
More goals for ICDE
 Increased access to home and
community based care
 Effective, person-centered care
coordination across acute, primary,
mental health, and long term care
 Streamlined bureaucracy
Advocates’ Approach to ICDE
 State courted advocacy community for
years seeking support first for concept of
managed long term supports & services
and, later, for ICDE.
 Advocates cautious but supportive
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Seeking new ways to solve intractable
problems
Significant, long-standing trust between
state and advocacy community
Advocates’ Toolkit
 Rely on existing broad coalitions of aging
and disability advocates
 With support of Community Catalyst,
Atlantic Philanthropies, and Michigan
Consumers for Healthcare, expand
outreach efforts, utilize more
sophisticated communications, learn
from advocates in other states, and
advocate with health plans & providers.
Advocacy Strategies
 Aging and disability communities present
a united front, consistent message
 Maintain relationships Medicaid staff
 Offer help, be credible, show up in force
 Demand consumer involvement
 Provide real life stories/challenges to
shape demonstration
 Say thank you when appropriate
Advocacy Successes
 Proposal, RFP, and MOU reflected
shared vision, vocabulary, goals
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Person-centered, permits self-direction
Promotion of home & comm’y based care
Strong consumer role in governance of
managed care organizations
Shared vision of strong ombudsman
program w/ legal support
Many specific quality measures
More advocacy successes
 Consumer/advocacy involvement on all
workgroups, funding and support to
promote consumer engagement
 Unprecedented access to state officials;
opportunities to review, edit or draft
part/all of key documents
 Bifurcated delivery system to preserve
perceived gains by mental health
community (crucial to MH/ID community)
Limitations, challenges of
“Michigan nice”
 Must balance value of access, trust,
relationships with state officials and need
to be uncompromising advocates
 Often reached agreement with state
officials only to learn that CMS or
Department’s legal counsel nixed plans
 Supported ICDE from start but saw
advantages shrink due to unanticipated
barriers and time/staff constraints.
Next steps
 Expand advocacy to health plans and
provider networks
 Develop regional Advisory Councils
 Support consumers on managed care
boards, state Stakeholder group
 Review, draft all consumer notices, info.
 Develop ombudsman program with both
individual and systemic advocacy role
Thanks and Questions?
Alison Hirschel
Michigan Voices for Better Health
Michigan Poverty Law Program
hirschel@lsscm.org
(517) 394-2985, x 231