Funder: The Commonwealth Fund and The SCAN Foundation

Author: Alexandra Kruse, Stephanie Gibbs, Leah Smith, Center for Health Care Strategies

November 2017 | Brief


Today, there are more than 11 million individuals who receive services from both Medicare and Medicaid. For these dually eligible beneficiaries, care is often fragmented across a wide array of medical, behavioral health, and long-term care providers. All of these services and supports need to be coordinated effectively to improve care for this population, yet Medicare and Medicaid offer otherwise uncoordinated systems of care with different eligibility criteria, benefits, provider networks, and enrollment processes.

Following the creation of the Centers for Medicare & Medicaid Services’ Medicare-Medicaid Coordination Office in 2010, state policymakers and their federal and health plan partners are increasingly seeking opportunities to improve integration for dually eligible beneficiaries. This brief, based on the experiences of 10 states with pioneering integrated care programs, describes key features of effective integrated care programs and presents top policy considerations driving state investment in these programs.

The brief was developed as part of Implementing New Systems of Integration for Dually Eligible Enrollees, a national initiative made possible by The Commonwealth Fund and The SCAN Foundation.