Over nine million people are fully eligible for both Medicare and Medicaid benefits. These individuals must navigate two systems of care with different benefit structures, provider networks, cost structures, and administrative rules and policies.
This complexity would be difficult for anyone, but full-benefit dually eligible individuals also often have multiple chronic physical and behavioral health conditions, functional limitations, and social support needs that make the task all the more challenging. Models such as the Program of All-Inclusive Care for the Elderly, demonstrations under the federal Financial Alignment Initiative, and Dual Eligible Special Needs Plans (D-SNPs) are all designed to integrate Medicare and Medicaid, but how effective are they in providing the care coordination that full-benefit dually eligible individuals need?
This Health Affairs blog post, coauthored by CHCS’ Nancy Archibald and Molly Knowles, highlights the importance of effective care coordination in delivering better outcomes for dually eligible individuals and how states can close the gaps between federal expectations and state-level realities around care coordination, with a particular focus on D-SNPs.