Today, more than 10 million Americans are defined as “dual eligibles” — people who are elderly or have disabilities and are covered by both Medicare and Medicaid. Their health care costs are substantial, nearly double those of other adults covered by Medicare and eight times higher than Medicaid spending for children. Integration is a major challenge since Medicaid and Medicare are governed by their own delivery, financing, and administrative policies and procedures that result in misaligned benefit structures, opportunities for cost-shifting, and unresolved tensions between the federal and state governments.
The Integrated Care Program was designed to help states achieve their goals around the integration of care across service settings and funding streams for those eligible for Medicaid and Medicare. Over the two-year initiative, five states — Florida, Minnesota, New Mexico, New York, and Washington — developed programs to integrate the financing, delivery, and administration of primary, acute, behavioral health, and long-term care services and supports for adults who are dually eligible for Medicaid and Medicare, as well as those who receive services solely through Medicaid.
Participating states received technical assistance and training for the development and implementation of integrated care programs. Efforts specifically focused on planning requirements for state contracts with Medicare Advantage Special Needs Plans.