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About the Demonstration

Demonstration

The South Carolina Dual Eligible (SCDuE) Demonstration is a pilot project to integrate and coordinate care for beneficiaries with both Medicare and Medicaid. The Demonstration will address the weaknesses in the current health care delivery system by realigning incentives to allow Medicare and Medicaid services to work as a single coordinated model. Through shared savings, the State will be able to focus on providing preventative services, and reducing avoidable emergency department visits and hospital stays. This program will also delay the need for institutional long-term care by increasing access to home and community based services. The Demonstration is a catalyst for change and embraces the State's broader coordinated care initiatives to purchase quality health outcomes from a clinically integrated, patient-centered model that delivers care at the right time and in the most appropriate setting.

Overall Goals

Improve health outcomes

• Delay the need for nursing facility care

• Reduce avoidable emergency department visits and hospital readmissions

• Increase access to home and community based services

Target Population

Full-Benefit

• Age 65+

• Not in an institution (at the time of enrollment)

• Not enrolled in PACE

• Non-DDSN waiver

• Not enrolled in Hospice

• Not receiving ESRD services

Covered Benefits

Medicaid State Plan services including nursing facilities and behavioral health services

• Home and Community Based Waiver Services

• Medicare services including primary and acute care, Part D, and skilled nursing facility services

State Demographics

Total Full-Benefit Duals: 131,090

• Total Eligible for the Demonstration: 53,600

Financial Model

Capitated

Geography

Statewide implementation

Proposed Implementation

July 1, 2014 – voluntary enrollment

January 1, 2015 – begin passive enrollment/auto-assignment

Prospective CICOs

Absolute Total Care, Inc.

• Advicare

• Humana Health Plan, Inc.

• Molina Healthcare of South Carolina, Inc.

• Select Health of South Carolina

• WellCare of South Carolina

Contact Us

Website | https://msp.scdhhs.gov/scdue/

• Email | scdue@scdhhs.gov

 

 

Link to September 2013 SCDuE Update | PDF

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