States integrating care for dually eligible individuals must ensure that health and social service support needs are addressed promptly. Stratifying Medicare-Medicaid enrollees by their level of need may help states and health plans to better prioritize and promptly address care management needs to ensure high-quality, timely care.

This brief describes how three states — California, Ohio, and Virginia — require integrated health plans to stratify Medicare-Medicaid enrollees by their level of need within capitated financial alignment demonstrations. It details each state’s stratification process, including the data used, risk groups, and assessment time frames. This information can help guide states implementing financial alignment demonstrations, as well as states and health plans integrating care through Dual Eligible Special Needs Plans or managed long-term services and supports programs.

Posted: June 2022