Funder: Centers for Medicare & Medicaid Services

Author: Alice Lind and Allison Hamblin, Center for Health Care Strategies, and Brendan Hogan and Beth Waldman, Bailit Health Purchasing

September 2013 |


The service needs of Medicare-Medicaid enrollees (also known as “dual eligibles”) make them particularly well suited for inclusion in the programs being developed under the new Medicaid health home state plan option under section 2703 of the Affordable Care Act (ACA). Including them in these programs offers potential benefits for both enrollees and states. However, their inclusion may pose several operational challenges for states, since most of their primary and acute care services are provided through Medicare rather than Medicaid.

This brief, developed by the Integrated Care Resource Center, outlines the challenges facing states when including Medicare-Medicaid enrollees in health homes and details considerations for developing programs that will best meet the needs of this population.