1. Michigan’s Journey to Integrated Care for Dual Eligibles Alison Hirschel Michigan Poverty Law Program & Michigan Voices for Better Health

2. 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.

3. 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”

4. State’s goals for ICDE:  Improved quality and enrollee satisfaction  “Choice and voice” for consumers  Seamless access to services

5. 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

6. 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 Seeking new ways to solve intractable problems Significant, long-standing trust between state and advocacy community

7. 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.

8. 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

9. Advocacy Successes  Proposal, RFP, and MOU reflected shared vision, vocabulary, goals 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

10. 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)

11. 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.

12. 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

13. Thanks and Questions? Alison Hirschel Michigan Voices for Better Health Michigan Poverty Law Program hirschel@lsscm.org (517) 394-2985, x 231