Start: May 2009

End: December 2010

Funder: The Commonwealth Fund


The Transforming Care for Dual Eligibles initiative was developed by CHCS to increase the number of dual eligibles who benefit from the improved quality and cost-effectiveness associated with integrating care. Of the approximately 1.5 million dual eligible adults who receive care via Medicare Advantage plans (including Special Needs Plans), only about 120,000 are enrolled in programs that fully integrate the administration, financing and delivery of Medicare and Medicaid services. Instead, the vast majority of the nation’s more than eight million dual eligible adults (over 80 percent) receive care through Medicare fee-for-service and stand-alone Medicare Prescription Drug Plans.

Under Transforming Care for Dual Eligibles, CHCS worked with seven states — Colorado, Maryland, Massachusetts, Michigan, Pennsylvania, Texas, and Vermont — to develop and implement innovative strategies for integrating care. Efforts focused on eliminating the barriers to integrating care via Special Needs Plans (SNPs) and supporting the development of non-SNP alternatives. Through the 18-month initiative, participating states received in-depth technical assistance covering program design, care models, financing mechanisms and contracting strategies CHCS also worked closely with states and the Centers for Medicare and Medicaid Services (CMS) to identify new avenues for Medicare-Medicaid integration.

The Transforming Care initiative continues the work begun by CMS and five states under CHCS’ earlier Integrated Care Program to address operational hurdles to integrating care by contracting with SNPs. The program’s goal is to develop a range of integrated delivery models for dual eligibles that can be implemented by other states across the country. Lessons from participating states were disseminated to Medicaid stakeholders throughout the course of the initiative.