Integrate Benefits for Individuals Dually Eligible for Medicare and Medicaid

More than 12 million individuals are dually eligible for Medicare and Medicaid. Having two separate insurers for physical health and long-term services and supports (LTSS) needs can create tremendous confusion for beneficiaries, who must navigate two distinct and complex provider delivery systems. The fragmentation and misaligned incentives between Medicare and Medicaid may lead to discontinuity and duplication of care, poor health outcomes, and stressful beneficiary experiences.

This strategy describes different approaches and implementation mechanisms that states have used to integrate Medicare and Medicaid benefits, along with program case studies:

Approach

  • Aligning Medicare and Medicaid financing and care delivery for dually eligible beneficiaries with the goal of improving access to services and providers, and streamlining administrative processes

 Implementation Mechanisms

  • Financial Alignment Initiative
  • Fully Integrated Dual Eligible Special Needs Plans
  • Aligned managed LTSS and D-SNPs through state Medicaid agency contracting authority
  • Section 1115 waiver

State Case Studies

  • Creating a path toward alignment (NJ, AZ)
  • Aligning administrative processes for Senior Health Options beneficiaries (MN)
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