Foundational misalignments between Medicare and Medicaid can make it very difficult for dually eligible individuals to access the care and services they need. While the responsibility for designing and implementing programs that integrate Medicare and Medicaid services and financing largely rests with states, strong federal leadership has been essential in supporting these efforts. These federal-state partnerships have expanded access to integrated care for millions of dually eligible individuals nationwide.

The 2025 budget reconciliation bill (H.R. 1) introduces substantial Medicaid eligibility and financing reforms that may require states to significantly shift their priorities. The law introduces Medicaid eligibility and financing reforms, including work requirements for certain populations, more frequent eligibility determinations, and a projected $900 billion reduction in federal Medicaid spending over 10 years. Continued federal support will be critical to sustaining bipartisan progress toward advancing integrated care.

This Health Affairs Forefront blog post, authored by the Center for Health Care Strategies and partners at the Bipartisan Policy Center, examines opportunities for federal leadership to support Medicare-Medicaid integration in today’s evolving policy landscape. Drawing on the experiences of states transitioning from the federal Financial Alignment Initiative (FAI) to integrated Medicare Advantage dual eligible special needs plan (D-SNP) programs, it highlights the value of federal support for these efforts.