People dually eligible for Medicare and Medicaid often have complex medical and social needs. Successful integrated care incorporates care management models that are person-centered and culturally/linguistically appropriate. The resources in this section describe how integrated care programs can build care management models that meet the needs of this population.
Coordinating Physical and Behavioral Health Services for Dually Eligible Members with Serious Mental Illness
Describes a robust physical and behavioral health care coordination and member engagement model used by a health plan serving dually eligible individuals with serious mental illness.
Facilitating Community Transitions for Dually Eligible Beneficiaries
Highlights how two health plans in California developed programs to successfully transition dually eligible members in need of long-term services and supports from institutional to community settings.
Information-Sharing Considerations for Health Plan Members with Opioid Use Disorder: A Q&A with Legal Experts
Offers perspectives from legal experts on ways that health plans can share information for care coordination of dually eligible individuals with substance use disorder diagnoses.
Providing Value-Added Services for Medicare-Medicaid Enrollees: Considerations for Integrated Health Plans
Explores how health plans are addressing members’ service needs that are beyond the scope of traditionally covered Medicare or Medicaid services, as well as assessing the value of offering these services.
State Insights on Refining Integrated Care for Dually Eligible Beneficiaries
Highlights ways in which states have refined their integrated care programs to improve care coordination, experience of care, enrollment, and health plan sustainability.
Ensuring Stable Housing for Medicare-Medicaid Enrollees with Long-Term Care Needs
Describes how several states are addressing the housing needs of dually eligible beneficiaries who use long-term services and supports.
Housing Options for High-Need Dually Eligible Individuals: Health Plan of San Mateo Pilot
Describes a pilot program developed by a health plan that was designed to help dually eligible individuals in nursing facilities transition back to community living and support those at risk of nursing home placement to remain in the community.
Interdisciplinary Care Teams for Medicare-Medicaid Enrollees: Considerations for States
Describes key considerations around developing and overseeing interdisciplinary care teams and explores how eight states addressed these issues.
Risk Stratification to Inform Care Management for Medicare-Medicaid Enrollees: State Strategies
Describes state risk stratification requirements for Medicare-Medicaid Plan enrollees, including the data used, risk groups, and assessment time frames.
From the Beneficiary Perspective: Core Elements to Guide Integrated Care for Dual Eligibles
Details core program design elements that are critical for achieving high-quality, patient-centered, and cost-effective care for dually eligible individuals.