The more than nine million individuals enrolled in both Medicare and Medicaid often receive care that is fragmented, poorly coordinated, and high-cost. Integrating their care is difficult because of the challenges associated with aligning the programs’ financial incentives and reimbursement processes. New financial alignment models provide states with opportunities to better integrate the care of these beneficiaries.
This brief from the Center for Health Care Strategies explores considerations for establishing reimbursement rates and performance incentives for the capitated and managed fee-for-service financial models. In addition, the brief describes ways that state variability may affect reimbursement methodologies.
This technical assistance brief is part of CHCS’ Technical Assistance for Dual Eligible Integrated Care Demonstrations program, made possible through The SCAN Foundation and The Commonwealth Fund. Through this program, CHCS is helping demonstration states develop and implement integrated-care models for individuals eligible for both Medicare and Medicaid services.