Today, more than seven million Americans are defined as “dual eligibles” — people who are elderly or have disabilities and are covered by both Medicare and Medicaid. Their health care costs are substantial, nearly double those of other adults covered by Medicare and eight times higher than Medicaid spending for children. Integration is a major challenge since Medicaid and Medicare are governed by their own delivery, financing, and administrative policies and procedures — resulting in misaligned benefit structures, opportunities for cost-shifting, and unresolved tensions between the federal and state governments.
In 2005, the Center for Health Care Strategies launched the Integrated Care Program (ICP) to support state efforts to integrate the administration, delivery, and financing of services for dual eligibles (and disabled beneficiaries who are covered only by Medicaid). Over the two-year initiative, five states — Florida, Minnesota, New Mexico, New York, and Washington — developed new approaches to integrate care for dual eligibles.
This external evaluation, which documents the activities of the Integrated Care Program, provides a comprehensive view of the progress states have made in exploring models for integration as well as the challenges that still remain. It describes the five states’ experiences in developing integrated care models, reviews federal and state progress during the initiative, and outlines key considerations for states interested in pursuing integration for dual eligible beneficiaries.