Funder: The Commonwealth Fund

Author: Rob Houston and Michelle Herman Soper, Center for Health Care Strategies

April 2015 |


States and the federal government are pursuing new approaches to improve alignment and coordination between Medicare and Medicaid for dually eligible individuals. Some states are exploring Medicaid accountable care organizations (ACOs) as one potential approach to improving outcomes and reducing expenditures for these beneficiaries. However, when deciding whether to include Medicare-Medicaid enrollees in Medicaid ACO programs, states must weigh the feasibility and potential benefits against potential costs and complexities.

This brief, made possible through support from The Commonwealth Fund, explores the feasibility of including Medicare-Medicaid enrollees in Medicaid ACO programs from the perspective of the eight states — Colorado, Maine, Massachusetts, Minnesota, New York, Oregon, Vermont, and Washington — taking part in The Commonwealth Fund-sponsored Medicaid ACO Learning Collaborative. The brief describes the challenges of incorporating Medicare-Medicaid enrollees in Medicaid ACO programs, reviews state considerations of these barriers, and presents emerging thinking on the potential of using this model for achieving better care for Medicare-Medicaid enrollees at lower costs.