ACAP Dual Eligibles Toolkit: Summary Data for Oregon Compiled by: Special Needs Consulting Services (SNCS)

Key Information, Oregon Oregon has roughly 50,000 “full duals” 56% 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 25% of Oregon’s duals’ costs are currently paid via capitation; 75% via FFS Oregon 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 Oregon’s duals into coordinated care also makes market positioning critically important for MCOs interested in serving this subgroup

Estimated PMPM Cost, Oregon Full Duals, 2008 Age <65 Age 65+ All Full Duals Average Eligibles 22,269 28,340 50,609 Total Medicaid Cost $834 $1,313 $1,102 Nursing Home $111 $624 $399 Capitated Care $227 $168 $194 HCBS Waiver & Prosthetics $409 $450 $432 Personal Support $29 $22 $25 ICF/MR $16 $8 $11 All Other Medicaid $42 Estimated Medicare Costs $796 $898 $853 Part A $336 $288 Part B $285 $373 $334 Part D $284 $189 $231 Total Costs, Medicaid & Medicare $1,630 $2,211 $1,956

Estimated Total Dollar Cost, Oregon Full Duals, 2008 Age <65 Age 65+ All Full Duals Average Eligibles 22,269 28,340 50,609 Total Medicaid Cost $222,772,069 $446,669,150 669,441,219 Nursing Home $29,706,745 $212,361,268 242,068,013 Capitated Care $60,696,810 $57,177,097 117,873,907 HCBS Waiver & Prosthetics $109,194,681 $152,873,807 262,068,488 Personal Support $7,699,914 $7,387,767 15,087,681 ICF/MR $4,259,942 $2,668,288 6,928,230 All Other Medicaid $11,213,977 $14,200,923 $25,414,900 Estimated Medicare Costs $212,796,290 $305,367,589 $518,163,879 Part A $60,682,666 $114,430,765 $175,113,430 Part B $76,098,570 $126,803,268 $202,901,838 Part D $76,015,054 $64,133,556 $140,148,610 Total Costs, Medicaid & Medicare $435,568,359 $752,036,739 $1,187,605,098

Publicly Available Resources Containing Data and/or Other Information About Oregon’s Dual Eligibles Medicare-Medicaid Enrollee State Profile, Oregon, Centers for Medicare & Medicaid Services http://www.integratedcareresourcecenter.com/PDFs/StateProfileOR.pdf Serving Individuals Eligible for both Medicare and Medicaid: Oregon’s Proposal, Oregon Health Authority https://cco.health.oregon.gov/Pages/Medicare-Medicaid-Proposal.aspx 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%20Coordination%20for%20Dual%20Eligibles-%20FINAL.pdf